The College has been undertaking an Assessment Review over the last two years. We have looked carefully at whether our current assessments and exams continue to provide the best evidence that paediatric doctors in training are ready to progress through each stage and are prepared for CCT (Certification of Completion of Training).
Our starting point was a simple question: what do we need to assess, and what is the best way to assess it?
There are two parts to the review: workplace-based assessments and the MRCPCH Clinical exam. Work on the latter has involved experienced examiners, doctors in training, College staff, and children and young people, ensuring that we consider every aspect.
On Tuesday 13 October we will open a consultation on our proposed changes to the exam. College members who are in training or who support training or exams will get an email with a link to the consultation.
Why are we reviewing the MRCPCH Clinical exam?
The exam now sits at the end of Specialty Training 4 (ST4). At this point, key higher-level skills include interpretation of clinical knowledge, making complex decisions, communicating effectively and exercising sound professional judgement.
We've considered how the exam can best assess these skills. While clinical examination skills of infants, children and young people remain essential, our Assessment Review identified these are better assessed earlier in training. So we are introducing a new workplace-based assessment, Observed Assessment of Clinical Skills (OACS), taken at ST1 and ST2.
This allows the exam to focus on clinical reasoning and decision-making through scenarios with simulated patients and role players.
What changes are we proposing, and why?
- We will have standardised scenarios and use role players
We will no longer involve children and young people (paediatric patients) in the MRCPCH Clinical exam. Rather, having role players in standardised scenarios will reduce variation and support improved reliability.
The exam sits at the end of ST4 and so needs to test higher-level capabilities. A doctor in training's clinical examination skills will be assessed using the new OACS assessment before the end of ST2.
- Each station will be ten minutes in length
We will no longer have different timings for the stations.
Standardised timings will mean each candidate has the same amount of time to demonstrate their skills across scenarios, which will provide a more consistent and fair assessment experience. This supports improved standardisation across the exam and reduces any unnecessary variation.
Candidates will continue to be able to apply for reasonable adjustments.
- Each station will use the same four domains
Each station will have the same four domains for candidate assessment:
- information gathering
- clinical decision making
- clinical management skills
- patient-centred relationships in healthcare.
This ensures all domains are assessed equally and repeatedly sampled, supporting more reliable assessment of each domain and skill.
- There will be 12 stations with a consistent format
The clinical exam will still be on an OCSE (Objective Structured Clinical Examination) circuit.
We will have 12 stations, rather than 10 stations. The increased number of stations will help optimise reliability by reducing the influence of performance in any one scenario. It also provides more scoring points.
Each station will have the same format to reduce unnecessary variation.
What will remain the same?
While we are proposing important changes to the exam's format and delivery, some fundamental aspects will not change:
- It will remain the final component of the MRCPCH; candidates will still need to successfully complete the three theory exams first.
- The existing regulations about exam attempts and the seven-year registration period will remain as they are.
- The purpose of the exam will be the same: to provide a robust assessment of the knowledge, skills and behaviours expected of a doctor progressing through paediatric training.
How did we test the new format and delivery?
We ran two pilot exams in December 2025 and June 2026, allowing us to test new formats, gather feedback from candidates and examiners, and evaluate how effectively the proposed changes meet our assessment goals.
The pilots provided positive findings, including encouraging reliability results. They helped us further refine the exam to support our aims of increased consistency and optimised reliability.
How can you get involved in our consultation?
One of the strongest themes throughout the Assessment Review has been the value of engagement with our members and stakeholders. You may have participated in our consultation on the workplace-based assessments earlier this year.
On 13 October we will email the consultation to members who are in paediatric training, educational supervisors and others who support paediatric training and the MRCPCH Clinical exam in the UK and internationally. Please look out for this email, which will come from RCPCH Education and Training. You'll have a few weeks to respond and we look forward to hearing from many of you.
What happens after the consultation?
We will review all responses to the consultation before submitting our final proposal to the General Medical Council.
The proposed changes seek to improve consistency, strengthen reliability and better assess clinical reasoning and decision-making skills that are central to paediatric practice. They are designed to ensure that the MRCPCH Clinical remains a trusted and respected assessment for future generations of paediatricians.
We would like to thank all the doctors in training, examiners and colleagues who have contributed to the Assessment Review so far. Your expertise, feedback and willingness to engage with change have been invaluable, and we look forward to continuing these conversations as the next phase of consultation begins.