MRCPsych Paper B: The Complete Guide to Critical Review, Clinical Topics and How to Pass

MRCPsych Paper B is the second written examination for Membership of the Royal College of Psychiatrists. Where Paper A focuses on the scientific and theoretical basis of psychiatry, Paper B moves into clinical practice across the psychiatric subspecialties and adds a substantial critical review component testing research methods, statistics and the appraisal of evidence. For many trainees the critical review third is the part that feels least familiar, and the part that most rewards structured preparation. This guide covers the format, eligibility, the syllabus weighting and how to revise effectively.

What is MRCPsych Paper B?

Paper B is a written paper set by the Royal College of Psychiatrists that assesses critical review and the clinical topics in psychiatry. Together with Paper A and the Clinical Assessment of Skills and Competencies (CASC), it makes up the MRCPsych examination. Trainees usually progress through the MRCPsych during core psychiatry training before moving into higher specialty training, and passing both written papers is one of the requirements for sitting the CASC.

MRCPsych Paper B format and structure

• One three-hour paper worth 150 marks, made up of 150 questions.
• Approximately two-thirds multiple choice questions (MCQs) and one-third extended matching item questions (EMIs).
• One-third of the paper covers critical review.
• Two-thirds of the paper covers clinical topics across the psychiatric subspecialties.
• Papers A and B are sat online; the College publishes guidance and a sample exam for taking them.

In the MCQ items you choose the single best answer from the options given. In the EMI items, a shared list of options is used for a group of related scenarios, and you match each scenario to the best option. Three hours for 150 questions gives you just over a minute per question, so efficient handling of the longer critical review stems matters.

Who can sit MRCPsych Paper B?

The College states that you are eligible to sit Paper B if you are on an approved training programme, and it recommends having 12 months' experience in psychiatry before attempting it. Alternatively, you may be eligible if you are in a post recognised by your hospital or trust as having contracted time and funding for educational training, with dedicated time in your job plan for activities such as journal clubs, grand rounds, an MRCPsych course or equivalent, study leave and weekly educational supervision. Read the College's full eligibility criteria and regulations before you apply.

MRCPsych Paper B syllabus: where to focus

The College publishes the approximate split of marks on the 150-mark paper, and it is the clearest guide to your revision priorities:

• Critical review: around 33.5%, or 50 marks, the single largest section.
• General adult psychiatry: around 20%, or 30 marks.
• Old age psychiatry and child and adolescent psychiatry: around 9% each, or 14 marks each.
• Substance misuse and addictions: around 6.5%, or 10 marks.
• Organisation and delivery of psychiatric services, psychotherapy, forensic psychiatry and psychiatry of learning disability: around 5.5% each, or 8 marks each.

Critical review covers research methodology, study design, bias and confounding, statistics, measures of effect, diagnostic test performance, systematic reviews and meta-analysis, and the appraisal of published evidence. It is worth as much as general adult psychiatry and old age psychiatry combined, and it is a skill that improves reliably with practice.

The College has also announced an update to the Paper A and Paper B syllabi to align them with the 2022 Core Psychiatry Curriculum, coming into effect for exams from 2027. Make sure you revise against the syllabus that applies to your sitting.

A realistic MRCPsych Paper B study plan

Paper B rewards running two tracks in parallel: clinical psychiatry and critical review.

• Phase 1, foundations: build critical review from first principles, learning study designs, the core statistics and the calculations, such as sensitivity, specificity, predictive values, risk ratios and number needed to treat. Alongside this, work through general adult psychiatry with questions in tutor mode.
• Phase 2, breadth: cover the subspecialties, giving old age and child and adolescent psychiatry proportionate time, and keep critical review active with a few questions every day. Read relevant national guidance on prescribing, assessment and services.
• Phase 3, simulation: sit full three-hour, 150-question papers under timed conditions, review performance by section, and target the areas costing you the most marks.

Common mistakes candidates make

• Leaving critical review until last, despite it carrying a third of the marks.
• Learning statistical definitions without practising the calculations, which questions frequently require.
• Concentrating on general adult psychiatry and neglecting smaller subspecialties such as learning disability, forensic psychiatry and psychotherapy.
• Revising from outdated material without checking which syllabus version applies to the sitting.
• Not practising EMIs, which need a different reading strategy from single best answer items.

Exam technique and what to expect on the day

With a little over a minute per question, keep a steady pace and avoid getting stuck. Critical review items can come with longer stems or extracts, so read the question first, then look for the information you need rather than reading every line. For calculations, write out a quick two-by-two table on your workings and double-check which value the question asks for. For EMIs, read the scenario and form your answer before scanning the option list. Flag uncertain items, return to them later, and make sure every question has an answer. Read the College's online exam guidance and try the sample exam beforehand so the interface holds no surprises.

The best way to revise for MRCPsych Paper B

Paper B is entirely MCQ and EMI, so a question bank mapped to the Paper B syllabus, with dedicated critical review practice, is the most efficient way to prepare. Explanations that walk through each calculation and explain why each study design or statistical test is right or wrong will build the critical review skill much faster than reading a statistics textbook alone. Use performance tracking to balance critical review with clinical topics, revisit questions you got wrong, and finish with full timed papers.

Passmed's MRCPsych Paper B question bank is written by qualified doctors and mapped to the RCPsych syllabus, with worked critical review explanations and performance tracking across every clinical subspecialty. Explore the question bank →

Frequently asked questions

How many questions are in MRCPsych Paper B?

150 questions worth 150 marks in a single three-hour paper, approximately two-thirds MCQs and one-third EMIs.

How much of Paper B is critical review?

About a third. The College's published split allocates around 50 of the 150 marks to critical review, with the remaining two-thirds on clinical topics.

Do I need to pass Paper A before Paper B?

The College sets separate eligibility criteria for each paper. You need to pass both written papers before sitting the CASC, so check the current regulations for any rules on order.

How much psychiatry experience do I need for Paper B?

The College recommends 12 months' experience in psychiatry before attempting Paper B, alongside being on an approved training programme or in a recognised post with educational time.

Is the Paper B syllabus changing?

Yes. The College is updating the Paper A and Paper B syllabi to align with the 2022 Core Psychiatry Curriculum, so check which version applies to your sitting.

Exam format details were checked against the official examining body (accessed October 2026). Specifications, dates and fees change, always confirm the current details on the official website before you sit.