The CASC

CASC is an OSCE-style clinical exam made up of 16 stations in total. There is one circuit of eight stations in the morning and one circuit of eight stations in the afternoon. They have scrapped previously linked stations.  Any clinical topic can come up, and only the most impractical scenarios are off-limits. Commonly tested stations include:

• Brief history-taking e.g. psychosis, depression
• Collateral history e.g. in dementia
• Risk assessment following self-harm information-giving e.g. ECT, medication, psychological therapies
• Discuss management plans with consultants and other members of staff, e.g. nursing students and ward managers.
• Physical examination e.g., EPSEs, cardiovascular, neurological

The CASC tests knowledge and communications skills such as history taking, explanation & advice, breaking bad news, and managing challenging consultations.

When you first look into the CASC exam, the pass rate may not fill you with optimism about passing it. However, having a rough idea of what the CASC involves at the start of your training and looking at the requirements in more detail when you are preparing for the papers is a good idea. When studying for the written papers, start thinking about how you would make history for the topics you are preparing and read the relevant leaflets for patients - imagine you are explaining it to a patient or relative. It may even make revising for the written papers less abstract!!

Speak to trainees who have sat the CASC. There is also information available online about past stations. You will need to train your body to recognize what seven minutes feels like - timed practice as early as possible is very important. Mock exams are a good way to prepare for the range of skills you have to show in a short time and also develop the ability to quickly change from one task to another. There are ‘OSCE timers’ apps available that have a one-minute warning bell and an ‘end of examination’ prompt which creates the right amount of anxiety/anticipation to prepare you for the big day.

Practical issues during the exam

You get a short time before each station. There is no defined way to use it this time, but make sure you use it! You may decide to take notes but don’t let this distract you from thinking about the question. You may just want to write the name of the patient and the key task that they have asked you to undertake, and a few areas you’d like to cover. You can also take notes during the first stations of each linked pair details will stick in your mind and they will give you another task with some information for the linked station. Taking notes can be a welcome distraction to the station, and you won’t be as present in the station.

The UK sitting of the CASC takes place at the English Institute of Sport in Sheffield. They hold it in a sizeable room with several circuits going on at once. Noise carries, and this includes the examiners and role-players talking to each other between candidates. Listen, but it might not always be positive comments and may derail you if things have not gone, and you thought. Remember, it’s only the opinions of people who have seen you for a few minutes in an already stressful setting.

There are no rest stations on the circuits, but you potentially have several hours to wait between the morning and afternoon sessions. There is enough time to have an excellent lunch and get focussed on the afternoon (though don’t rely on the café in the venue being open) Some people like to talk through the stations they have just sat with friends, others might find this frustrating and unhelpful Remember, there is nothing you can do to change things and you need to focus instead on the afternoon stations. What has gone on, however, may also highlight things you have missed out on which can then be remembered for the second circuit?

During each station, let the role-player set the initial agenda but make sure you steer things in the right direction later on if needed. Summarising is useful to double-check information and re-focus the interview. Listen for cues and address anxieties when they appear. Don’t be afraid to answer questions, even if the answer might not be something the patient might want to hear—this may be the only way to move on. Be careful not to ask double questions—the actor might only answer one part.

Books we found helpful for CASC

‘Pass the CASC’

CASC books are far from perfect. One of the most popular is ‘Pass the CASC’ by Dr. Seshni Moodliar. This has a list of all the stations that have previously come up and is a good way to map out your revision. The content is comprehensive, but some phrases suggested in the book have not served candidates well.

Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees

Although not written for the MRCPsych exam, "Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees" by Sarah Stringer is an excellent all-rounder book. It’s a practical guide to working as a psychiatry trainee and covers all commonly encountered situations. Many of these give good advice that would help in passing CASC.

The Maudsley Handbook of Practical Psychiatry 

The Maudsley Handbook of Practical Psychiatry has a section on special interview situations. This has some excellent advice about how to manage challenging situations.

Preparing for CASC:

Have a plan and stick to it. Plan out each day where you work through a list of previous stations together. Find someone you want to spend the day with and practice regularly. Make it fun and schedule in breaks. Be honest with each other when giving feedback. Check that your practice is going in the right direction by asking trainees who have passed the CASC for feedback. Many trainees find that organizing a small group of three to four trainees who are all about to sit CASC and meet regularly to go through stations, practice your approach, and learn from each other can be a great way to prepare. If you are in a more rural location and struggle to meet up, consider regular Skype meet-ups instead.