The Royal College of Psychiatrists regularly updates the CASC exam format and logistics. This article covers everything you need to know for the 2026 exam diets, including practical information about registration, fees, venues, and what to expect before, during, and after the exam.
2026 CASC Exam Dates
The UK CASC exam runs twice per year (referred to as "diets"): - Winter diet: January - Autumn diet: September
International sittings (Hong Kong and Singapore) take place once yearly on different schedules. Exact dates are confirmed by the Royal College of Psychiatrists on their website and communicated to eligible candidates. Always verify directly with the College as dates can occasionally shift.
Key Dates to Remember - **Registration opening**: Typically 3-4 months before the exam date - **Registration closing**: Usually 6-8 weeks before the exam — late applications are generally not accepted - **Venue confirmation**: You will receive venue allocation after registration closes - **Results release**: Approximately 6-8 weeks after each sitting
Exam Format Overview
The 2026 CASC exam continues with the established OSCE-style format: - Total stations: 16 - Circuits: 2 (8 stations each, with a break between them) - Station duration: 7 minutes each - Reading time: 4 minutes before each station in the morning circuit; 90 seconds before each station in the afternoon circuit - Total exam time: Approximately 3-4 hours (including the approximately 2.5-hour lunch break between circuits) - Linked pairs: Some stations come in linked pairs where two consecutive stations share a clinical scenario
What Hasn't Changed The fundamental structure of the CASC has been stable since its introduction in 2008. While specific scenarios rotate, the format, timing, and assessment methods remain consistent.
Station Types and Blueprint
The Royal College publishes a blueprint outlining the types of stations that can appear. Not every station type will appear in every sitting, but across all diets, the exam covers:
Clinical Tasks - **Psychiatric history taking**: Full histories, focused histories, collateral histories - **Mental state examination**: Explicit MSE stations and stations where MSE observation is implicitly assessed - **Risk assessment**: Suicide risk, violence risk, self-neglect, safeguarding - **Capacity assessment**: Decision-specific capacity assessment under the Mental Capacity Act 2005 - **Communication skills**: Breaking bad news, explaining diagnoses, discussing treatment options, obtaining consent - **Management discussions**: Discussing management plans with patients, relatives, or colleagues - **Emergency and acute scenarios**: Managing acute presentations (e.g., acute psychosis, deliberate self-harm, delirium, serotonin syndrome, neuroleptic malignant syndrome) - **Ethical and legal scenarios**: Mental Health Act, confidentiality dilemmas, consent, fitness to drive
Patient Populations Stations can involve patients from any age group and subspecialty: - General adult psychiatry (the most common) - Old age psychiatry (dementia, delirium, late-onset psychosis) - Child and adolescent psychiatry (ADHD, autism assessment with parents, eating disorders in young people) - Substance misuse (alcohol dependence, opiate substitution, motivational interviewing) - Forensic psychiatry (risk assessment in forensic contexts, fitness to plead) - Liaison psychiatry (capacity assessment in medical settings, medically unexplained symptoms) - Intellectual disability (communication adjustments, capacity, behavioural assessment) - Perinatal psychiatry (postnatal depression, medication in pregnancy/breastfeeding)
Examiner Marking Each station is marked by a trained examiner using a standardised mark scheme. Marks are typically given across domains: - **Content coverage**: Did you cover the essential clinical areas? - **Communication skills**: Was your approach empathic, clear, and patient-centred? - **Clinical judgement**: Did you demonstrate appropriate clinical reasoning and prioritisation?
Fee Structure and Financial Planning
- CASC exam fee: £1,254 - £1,628 (subject to annual review by the Royal College)
- Travel: May require overnight stay if the venue is far from home
- Accommodation: Budget for the night before the exam
- Study materials: Textbooks, online courses, CASC practice courses
- CASC preparation courses: Typically £200-£600
- AI practice platforms: Variable pricing
- Resit policy: Full fee payable for each attempt — there is no discount for resitting
Financial Support - Some training programmes or trusts may reimburse exam fees — check with your training programme director - The Royal College occasionally offers bursaries for candidates facing financial hardship — check the College website for current availability - Some medical defence organisations offer study grants
Registration Process
Step-by-Step 1. **Check eligibility**: You must have passed both MRCPsych Paper A and Paper B 2. **Log in to the Royal College examinations portal**: Registration is online 3. **Submit your application**: Provide your personal details, sponsorship/training information, and any reasonable adjustment requests 4. **Pay the fee**: Payment is typically required at the point of registration 5. **Receive confirmation**: You will receive an email confirming your registration 6. **Venue allocation**: You will be notified of your specific test centre after registration closes
Common Registration Issues - Ensure your College membership or affiliation is up to date before registering - Sponsorship requirements may vary for international candidates — check with the College - If you need reasonable adjustments, read the relevant section below
Exam Venues and Logistics
CASC exams are held at designated test centres, typically in UK cities. The Royal College uses several regular venues. International sittings are also available in some locations.
What to Expect at the Venue - You will be directed to a holding area where you wait before each circuit - Invigilators will brief you on the rules and logistics - You will be assigned a candidate number and directed to your starting station - The stations are arranged in a circuit — you move sequentially from one station to the next - There will be clear signage or invigilators to guide you - A break area is provided between circuits with refreshments (bring your own as a backup)
Reasonable Adjustments
If you have a disability, health condition, or specific learning difficulty that may affect your exam performance, you can request reasonable adjustments. These may include:
- Additional time per station (typically 25% extra)
- A separate room or reduced-distraction environment
- Enlarged print for candidate instructions
- Permission to use specific aids
- Breaks during the circuit
How to Apply - Submit your request at the point of registration — do not leave it until after registration closes - Provide supporting evidence: a letter from your GP, specialist, or educational psychologist - The College will review your request and confirm what adjustments will be made - If you have previously received adjustments for Paper A or Paper B, state this — it streamlines the process
Results, Feedback, and Appeals
Results - Results are typically released within 6-8 weeks of the exam - You will receive notification via email and can view your results on the College's online portal - Results indicate pass or fail, along with a breakdown of performance by station or domain
Feedback for Unsuccessful Candidates - Candidates who do not pass receive written feedback identifying their weaker areas - This feedback is invaluable for planning your resit preparation - Feedback is general rather than station-by-station, but it highlights themes (e.g., "risk assessment," "time management," "communication")
Appeals - If you believe there has been a procedural irregularity, you can submit an appeal to the College - Appeals must be submitted within a specified time frame (check the College regulations) - Appeals are considered on procedural grounds (e.g., exam conditions, marking errors), not on disagreement with clinical judgement
Resit Policy and Attempt Limits
- Candidates may attempt the CASC up to six times — always confirm current policy with the Royal College as this may change
- Full fee is payable for each attempt
- If you are a trainee in an approved programme, your training programme director may require you to develop an action plan before your next attempt
- Allow sufficient time between attempts to address your areas of weakness — many candidates benefit from waiting at least one diet before resitting
Preparation Timeline
A recommended 3-6 month preparation plan:
Month 1-2: Foundation Phase - **Theory review**: Psychiatric diagnoses, management guidelines (NICE), Mental Health Act, pharmacology - **Framework learning**: Internalise frameworks for history taking, risk assessment, MSE, capacity, SPIKES protocol - **Observation**: If possible, observe CASC practice sessions to understand the format and standard required - **Start casual practice**: Even 10-minute ad hoc practice sessions with colleagues build familiarity
Month 3-4: Intensive Practice Phase - **Regular practice**: 3-4 sessions per week, each covering 2-4 stations - **Variety**: Practice with different partners and different station types - **Feedback**: Seek specific, constructive feedback after every practice session — not just "that was good/bad" but "your risk assessment didn't cover means access" - **Video review**: Record yourself and watch it back at least once — this is uncomfortable but extremely effective - **Attend a course**: Consider a formal CASC preparation course — these are offered by numerous providers and typically include mock circuits with examiner feedback
Month 5-6: Refinement Phase - **Focus on weak areas**: By now you should know which station types you find hardest — practice these disproportionately - **Full mock circuits**: Complete at least 2-3 full 16-station mock circuits under timed conditions - **Exam technique**: Practice reading instructions and identifying the key task within 30 seconds - **Mental preparation**: Practice anxiety management techniques, visualisation, and between-station reset protocols - **Final 2 weeks**: Consolidate frameworks, practice your weakest 3-4 station types one more time, rest, and trust your preparation
How AI Practice Tools Complement Traditional Preparation
AI-powered CASC practice platforms offer several advantages as a supplement to traditional preparation methods:
- Unlimited availability: Practice any time, any day — no need to coordinate schedules with practice partners
- Realistic scenarios: AI simulated patients can present realistic psychiatric presentations and respond dynamically to your questions
- Structured feedback: Receive immediate, structured feedback on your performance against examiner-style criteria
- Repetition without fatigue: Practice the same scenario multiple times to refine your approach without exhausting a human practice partner
- Gap identification: AI feedback can identify patterns in your performance — such as consistently missing risk assessment or running over time — that you might not notice yourself
- Supplementary, not replacement: AI practice works best alongside face-to-face practice with colleagues and formal courses — it is a tool for increasing your practice volume and getting feedback between scheduled sessions