For international medical graduates (IMGs), the MRCPsych can feel like a moving target. The eligibility rules are complex, the exam tests UK-specific systems you may not have trained in, and the CASC assesses communication styles that differ from what you learned in your home country. But IMGs pass the MRCPsych every single diet — and many pass first time.
This guide is for anyone who trained outside the UK and wants to understand exactly what is different about this exam — and what to do about it.
Eligibility for IMGs
The Royal College of Psychiatrists offers two routes:
UK Training Route
You hold a GPST or Core Psychiatry Training (CT1–CT3) post in the UK. You can sit Paper A from CT1 and Paper B from CT2.
International (Non-Training) Route
You are practising psychiatry outside UK training but hold GMC registration and a recognised overseas qualification. Check the RCPsych website for the current equivalency requirements.
Always verify current eligibility criteria on the official RCPsych website before entering. Requirements can change between diets.
The 5 Biggest Mistakes IMGs Make
✗ Revising from DSM-5 instead of ICD-11
Fix: The RCPsych exams are based on ICD-11, not DSM-5. Diagnostic criteria, terminology, and category names differ significantly. Use ICD-11 as your primary reference.
✗ Using non-UK pharmacology resources
Fix: Psychopharmacology questions are based on BNF guidance and NICE recommendations. Drug names, doses, and approved indications differ from the WHO model or other national formularies. Use the BNF.
✗ Underestimating the statistics section
Fix: Paper A and Paper B both contain statistical and psychometric questions. Many IMGs have little clinical research statistics exposure. Start practising these early — they are very learnable with the right questions.
✗ Not practising UK communication style for CASC
Fix: The CASC assesses communication in the UK NHS context — shared decision-making, capacity assessment, safeguarding awareness, and specific risk assessment frameworks. Practise with UK training partners or actors.
✗ Treating it like a postgraduate exam from home
Fix: The MRCPsych tests both knowledge and its application to UK clinical practice. Questions will present scenarios in NHS settings with NHS pathways. Familiarity with the UK mental health system is essential.
CASC: What IMGs Need to Know
The CASC is where many IMGs struggle — not because of knowledge, but because of communication style. The exam expects:
✓ Patient-centred language — "I wonder if you'd be willing to tell me more about..." rather than direct questioning
✓ Explicit capacity and consent framing — assuming competence unless otherwise indicated
✓ Awareness of safeguarding obligations and when to involve other agencies
✓ Structured risk assessment using UK frameworks (not just generic psychiatric assessment)
✓ Ability to counsel about medications in plain English, checking understanding throughout
Resources That Work for IMGs
✓ ICD-11 — free online at icd.who.int, use the MMS version relevant to clinical psychiatry
✓ BNF (British National Formulary) — free at bnf.nice.org.uk for approved UK drug information
✓ NICE guidelines — focus on depression, psychosis, bipolar, dementia, and anxiety
✓ Mental Health Act 1983 (amended 2007) — understand the major sections (2, 3, 5(2), 5(4), 136)
✓ Practice with UK-style questions — the question style differs from most postgraduate exams
A Realistic Timeline for IMGs
Months 1–3: Familiarise yourself with UK psychiatric classification, BNF, and NICE guidelines. Work through Paper A topic questions.
Months 4–6: Intensive Paper A revision. Sit Paper A. Begin Paper B topics alongside clinical work.
Months 7–10: Paper B intensive revision. Focus on critical review. Sit Paper B.
Months 11–14: CASC preparation — structured role-play practice, all station types, linked pairs.
Month 15+: Sit CASC. Many IMGs pass within 15–18 months of starting a UK training post with consistent preparation.
► All questions on Psychgateway are written to the current RCPsych syllabus, with detailed explanations that explain the UK clinical context. Visit psychgateway.com/pricing