Paper B is a three-hour paper of 150 questions, and it is really two examinations bolted together. Two-thirds of the marks come from clinical psychiatry across the subspecialties, and one-third, roughly 50 marks, comes from critical review: research methods, statistics, epidemiology and the appraisal of evidence. Those are not related skills. A candidate can be an excellent clinical psychiatrist and score badly on a third of this paper, and many do, because they revise Paper B as a single subject and let the clinical material crowd out the methodology until the fortnight before.
Key takeaways
- Paper B is 150 questions in three hours, roughly two-thirds multiple choice and one-third extended matching items.
- One-third of the marks, about 50, are critical review, and two-thirds are clinical topics.
- General adult psychiatry is the largest single clinical block, at roughly a fifth of the whole paper.
- Track clinical and critical review performance separately, because a blended percentage hides which is sinking you.
- Critical review questions are long, so plan your pacing and rehearse it before the day.
Fifty marks that behave like a different exam
Fifty marks is not a rounding error. It is a third of the paper, and it can decide your result on its own.
Critical review tests whether you can read a study and judge it: whether the design answers the question, whether the population is relevant, whether the analysis is appropriate, whether bias or confounding could explain the result, what the effect size actually means, and whether the authors' conclusion is justified by what they found.
That is a methodological skill, and it is entirely separable from knowing psychiatry. It is also, unlike clinical psychiatry, finite and closed: a manageable set of concepts that recurs every diet in slightly different clothing. That combination, high value and finite content, makes it the best return on revision time in the paper, and it is the part most candidates leave until last.
Track the two separately
The measurement error that costs candidates most is watching a single percentage climb.
Your overall figure will be dominated by the clinical questions, because they are two-thirds of the paper, so it can rise steadily while your critical review performance sits stubbornly at forty per cent and you never notice.
Keep two dashboards. Set a separate target for each. And be honest about which one you have been avoiding, because it will be the one you find less enjoyable, and the exam does not care.
The clinical two-thirds, weighted properly
Within the clinical portion, the weighting is not flat either, and it is worth knowing.
General adult psychiatry is the single largest block, worth roughly a fifth of the whole paper on its own, which makes it comfortably the highest-yield clinical domain. Beyond it, the subspecialties are each worth less, but together they are substantial: old age, child and adolescent, forensic, learning disability, addictions, liaison and psychotherapy, along with the organisation and delivery of psychiatric services.
The temptation is to revise the subspecialty you are working in, which is precisely the trap. Weight your hours to the paper, which means general adult first, thoroughly, and the subspecialties covered properly rather than deeply.
For each disorder, revise the things the exam actually asks: the epidemiology and prevalence, the aetiology, the clinical features and how the presentation differs across populations, the current evidence-based treatment, and the course and prognosis. That last one is examined more than candidates expect and revised less.
Critical review is a method, not a body of knowledge
The reason candidates find critical review hard is that they try to memorise it, and it does not respond to memorisation.
It responds to a method, applied consistently to every study you meet: what was the question, what was the design and was it the right one, who was studied and are they relevant, what could have biased or confounded this, what does the effect size mean in practice rather than in statistics, and does the conclusion follow from the data.
We set that method out step by step in the five-step critical review method.
The point for your revision plan is that this is a skill you build by practising it on studies, not by reading about it. Twenty minutes twice a week, applying the method to a paper or to a practice question, from the beginning of your preparation, will do more than a fortnight of frantic reading at the end.
Pace the paper deliberately
Two structural features of Paper B interact badly if you have not planned for them.
Critical review questions tend to be long, because they have to give you enough of a study to appraise. And extended matching items, which are about a third of the paper, take longer to read and work through than single best answers.
Three hours for 150 questions gives you a little over a minute each on average, and averages conceal exactly this kind of asymmetry. A candidate who works through the paper in order at a uniform pace will meet the material that consumes the most time when they have the least of it left.
Plan the sequence, and rehearse it in a full-length timed mock. Many candidates find it works to take the shorter single best answer questions at pace first and reserve a substantial protected block for the extended matching sets and the long critical review items. Whatever you decide, decide it in advance and practise it, because a pacing plan you have never executed is not a plan.
Combine the tracks only at the end
A sequencing point. For most of your preparation, work the two tracks separately: clinical practice in clinical blocks, critical review practice in its own sessions, each with its own target and its own dashboard.
Bring them together only in the final phase, in full-length timed mocks that mix them in the proportions the real paper uses. That is when you discover whether your pacing plan survives contact with a long critical review question at question 120, which is exactly what you want to find out three weeks early rather than on the day.
Where iatroX fits
iatroX's MRCPsych Paper B bank covers the clinical topics and critical review as separately tracked domains, so you can see immediately which of the two is costing you marks rather than watching a blended figure that conceals a fifty-mark weakness. The adaptive engine targets the domain and subspecialty you are genuinely weak in rather than the one you happen to be working in, spaced repetition holds the epidemiological figures and treatment evidence that decay, and missed questions can be opened in the Socratic Tutor, which asks you to reason before it explains. Try it with free sample questions at iatroX. For the underlying measurement discipline, see why your Q-bank percentage is not your exam score.
Frequently asked questions
What is the format of MRCPsych Paper B? A three-hour paper of 150 questions worth 150 marks, roughly two-thirds multiple choice and one-third extended matching items. One-third of the marks cover critical review and two-thirds cover clinical topics.
How many marks is critical review worth? Roughly a third of the paper, about 50 marks. It is a methodological skill rather than a psychiatric one, it is finite and learnable, and it is the domain candidates most reliably postpone.
Which clinical topic carries the most marks? General adult psychiatry, at roughly a fifth of the whole paper, which makes it the highest-yield clinical domain by a clear margin. Weight your hours to it rather than to the subspecialty you happen to be working in.
How should I pace Paper B? Deliberately, and rehearse it. Critical review questions are long and extended matching items take longer to read than single best answers, so working through the paper at a uniform pace will leave you short of time exactly where you need it most.