The MRCPsych is the membership examination of the Royal College of Psychiatrists, required for progression from core to higher psychiatry training and ultimately for consultant practice. The written component consists of two papers — Paper A and Paper B — each testing fundamentally different content. This page explains what each paper covers, how they differ, and how they fit into the training pathway.
Paper A — sciences underpinning psychiatry
Paper A tests the biological, psychological, and social sciences that underpin psychiatric practice. This is not a clinical exam — it tests your understanding of why psychiatric conditions occur and how treatments work at a mechanistic level.
The exam contains 150 questions (a mix of SBA and EMQ formats) delivered in three hours. It is typically sat during core training (CT1 to CT3), though there is no formal sequencing requirement.
The content domains and their approximate weightings are as follows. Psychopharmacology accounts for roughly 25 per cent — drug mechanisms of action, receptor pharmacology, pharmacokinetics, cytochrome P450 interactions, side effect profiles, and serotonin syndrome. This is the single largest domain and the most common reason for failure. Neuroscience and neuroanatomy account for 15 per cent — neuroanatomical localisation, neurotransmitter pathways, neurophysiology (EEG patterns, sleep architecture), and neuropathology. Psychology accounts for 15 per cent — classical and operant conditioning, cognitive schemas, Piaget's developmental stages, attachment theory, and social psychology. Genetics and epidemiology account for 10 per cent. Statistics and research methods account for 10 per cent — NNT, NNH, sensitivity, specificity, confidence intervals, study design. Ethics and law account for 8 per cent. Human development, neurophysiology, and classification (ICD-11/DSM-5) make up the remainder.
The EMQ component presents themed option sets — for example, eight neurotransmitter receptors with three clinical stems asking you to match drug effects to receptor profiles. EMQ technique is distinct from SBA technique and must be practised separately.
Paper B — clinical psychiatry
Paper B tests your ability to assess, diagnose, and manage psychiatric conditions across all subspecialties. This is a clinical exam — it tests what you would do in practice, not the underlying science.
The exam format is the same as Paper A — 150 questions (SBA and EMQ) in three hours. It is typically sat during higher training (ST4 to ST6), though candidates can sit it during core training if they wish.
The content spans every psychiatric subspecialty. General adult psychiatry — schizophrenia (including treatment-resistant schizophrenia and the clozapine pathway), mood disorders (depression stepped care, bipolar disorder, perinatal), and anxiety disorders — accounts for roughly 35 to 40 per cent. The remaining questions cover old age psychiatry (dementia, BPSD, depression in the elderly), child and adolescent psychiatry (ADHD, autism, self-harm, eating disorders), forensic psychiatry (risk assessment, MAPPA, fitness to plead), liaison psychiatry (delirium, capacity assessment, self-harm in ED), substance misuse (alcohol detoxification, opioid substitution, novel psychoactive substances), personality disorders, perinatal psychiatry, intellectual disability, and psychotherapy approaches.
Mental Health Act sections and the Mental Capacity Act are heavily tested — approximately 8 per cent of the exam. You must know specific sections, durations, grounds for detention, appeal mechanisms, and the distinction between the MHA and MCA. Clinical approximation is insufficient — the questions expect precise legal knowledge.
How the papers relate
Paper A and Paper B are essentially different exams that happen to share a name. The sciences content in Paper A (pharmacology, neuroscience, psychology, statistics) has minimal overlap with the clinical content in Paper B (management algorithms, prescribing decisions, legal frameworks). Preparing for one does not prepare you for the other.
However, the pharmacology in Paper A provides the mechanistic understanding that makes Paper B prescribing decisions more intuitive. A candidate who understands dopamine receptor pharmacology from Paper A study will find clozapine prescribing questions in Paper B more approachable than a candidate who never engaged with the science.
Sitting strategy
Most trainees sit Paper A during CT2 or CT3, then Paper B during ST4 or ST5. Some trainees sit both in the same diet (they are scheduled on different days within the same window), which accelerates the exam timeline but requires simultaneous preparation for two very different exams.
If you are considering sitting both in the same diet, allow five to six months of preparation and use a platform that tracks your performance separately across Paper A and Paper B content. Conflating your sciences revision with your clinical revision is counterproductive.
Preparation
Paper A requires textbook revision — Stahl's for pharmacology, neuroscience resources for neuroanatomy, psychology textbooks for learning theory and developmental psychology, and a statistics primer. Paper B requires guideline reading — NICE mental health guidelines, the Maudsley Prescribing Guidelines, BAP guidelines, and the MHA/MCA.
Both papers require question bank practice — SBA and EMQ formats, timed, with adaptive topic targeting.
iatroX offers dedicated banks for Paper A and Paper B, each with over 1,500 questions including both SBA and EMQ formats. The adaptive algorithm tracks performance separately across each paper. All included at £29 per month or £99 per year.