One of the most common questions trainees ask is how to divide their time between Paper A and Paper B. The two papers test fundamentally different skill sets, yet they are often taken in the same sitting. Understanding the difference is the first step to an efficient study strategy.
The Core Difference
Paper A tests scientific foundations. It asks: do you understand the basic sciences that underpin psychiatric practice? This includes neuroanatomy, psychopharmacology, psychological theories, and classification systems. The answers are largely factual — you either know them or you do not.
Paper B tests clinical application and critical appraisal. It asks: can you apply your knowledge to clinical scenarios and can you critically evaluate research evidence? This includes clinical psychiatry topics (general adult, old age, child, forensic, learning disability), psychotherapy, and critical review skills.
Structure Comparison
| Element | Paper A | Paper B |
|---|---|---|
| Questions | 150 MCQ (SBA) | 150 MCQ (SBA) |
| Duration | 3 hours | 3 hours |
| Marks | 150 | 150 |
| Pass mark (approx.) | 60–65% | 60–65% |
| Question style | Factual recall + application | Clinical scenarios + critical appraisal |
| Key skill | Knowledge depth | Clinical reasoning + statistics |
Paper A: Domain Breakdown
- Neurosciences (27%): Neuroanatomy, neurophysiology, neurochemistry, neuroimaging, neuropsychology. The most feared section and the one with the most factual density.
- Psychopharmacology (22%): Mechanism of action, pharmacokinetics, side effects, interactions. Mechanism-based learning is essential here.
- Classification & Assessment (17%): ICD-11 diagnostic criteria, clinical assessment, psychometric properties of assessment tools.
- Psychological Models (17%): Behavioural, cognitive, psychodynamic, and social models. Know the key theorists and their contributions.
- Human Development (10%): Attachment theory, Piaget, Erikson, lifespan development.
- History & Philosophy (8%): Key figures in psychiatric history, ethical principles, and philosophical debates in psychiatry.
Paper B: Domain Breakdown
- Critical Review (33.5%): Statistics, epidemiology, research methodology, critical appraisal of RCTs, systematic reviews, and meta-analyses. This is the section that surprises most candidates — it is not just clinical psychiatry.
- General Adult Psychiatry (20%): Depressive disorders, bipolar disorder, schizophrenia spectrum, anxiety disorders, OCD, PTSD, eating disorders, somatoform disorders.
- Old Age Psychiatry (10%): Dementia, delirium, depression in older adults, late-life psychosis.
- Child & Adolescent Psychiatry (8%): Neurodevelopmental disorders, conduct disorder, emotional disorders in children.
- Substance Misuse (8%): Alcohol, opioids, stimulants, cannabis — withdrawal, intoxication, and long-term complications.
- Forensic Psychiatry (6%): MHA 1983, fitness to plead, criminal responsibility, risk assessment.
- Learning Disability (6%): Assessment, behavioural phenotypes, mental health in LD, legal framework.
- Psychotherapy (5%): CBT, psychodynamic therapy, DBT, CAT, family therapy. Know the indications and evidence base.
- Service Organisation (3.5%): Care pathways, NICE implementation, service models.
The Critical Review Factor
The critical review section deserves special attention. It accounts for 50 of the 150 marks — a third of the entire paper — yet many trainees underestimate its breadth. You need to understand:
- Statistical tests (t-test, chi-square, ANOVA, Mann-Whitney, correlation coefficients)
- Measures of effect (risk ratio, odds ratio, NNT, hazard ratio)
- Sensitivity, specificity, PPV, NPV, likelihood ratios
- Study designs (RCT, cohort, case-control, cross-sectional, qualitative)
- Bias types and how to identify them in published research
- Critical appraisal frameworks (CASP, SIGN, GRADE)
This is an area where simple question volume is insufficient. You need to engage with the concepts actively — calculating NNT from a 2×2 table, identifying the type of bias in a flawed study design, interpreting a forest plot from a meta-analysis.
Can You Prepare for Both Simultaneously?
Yes, but most trainees struggle because they study one domain at a time. A better approach is to interleave: 30 minutes of neuroscience in the morning, 30 minutes of critical review in the evening. This forces your brain to switch contexts, which improves long-term retention.
PsychStar covers both papers with 4,600+ questions and a cross-paper adaptive engine. If you struggle with dopamine pathways in Pharmacology (Paper A), the engine may present you with a psychotic disorders question (Paper B) that tests the same pathway conceptually. This cross-domain linking is something no static bank can replicate.
Try 5 free questions from both papers at psychstar.io/try to see the difference.