FRANZCP Written Exam (RANZCP) 2026 Study Guide: What You Actually Need to Know

This is a working guide for psychiatry trainees sitting the FRANZCP Written Examination in the next twelve months. It covers format, the MEQ approach, formulation expectations, the topics that actually appear, realistic timelines, and the failure modes that catch competent candidates. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 Australasian specialty exams because trainees from each specialty asked us to build for them. The FRANZCP Written Exam (RANZCP) curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

What the Written Examination actually is

The Written Examination is the focus of this guide. It has two papers sitting in the same session. Sorting out the format early saves weeks of misdirected preparation.

• MCQ paper: 140 items (Single Best Answer and Extended Matching Questions, option lists A to J) plus two Critical Analysis Problems (CAPs), 190 minutes total
• MEQ paper: 5 Modified Essay Questions, 150 minutes (computer-based from 2026; increases to 6 MEQs, 150 marks from March 2027)
• Sittings: twice per year, in March and September
• Pass mark: the college does not publish a fixed standardised pass mark, results are tier-graded after psychometric review of each paper

An MEQ is not a single essay. Each MEQ is a clinical vignette that unfolds across multiple sequential prompts. You answer one part, then more clinical information appears, then you answer the next. The marking scheme is granular: each sub-question has discrete marking points and is graded independently. A CAP is a short research abstract with data tables followed by 4 to 8 sub-questions on study design, bias, statistics, and evidence levels.

What the college actually tests

The RANZCP Fellowship curriculum maps to 347 learning outcomes across three blocks, tracked in the PRIMEX curriculum tracker:

• Stage 1 syllabus (81 LOs, 14 sections): interviewing, emergencies, diagnosis, basic sciences, treatments, critical appraisal, ethics, professionalism, legislation, development, psychology, cultural competence, patients and families, and specific disorders
• Stage 2 syllabus (230 LOs, areas A to K): generalist psychiatry, consultation-liaison, child and adolescent, addiction, forensic, old age, psychotherapies, indigenous and Maori, rural, intellectual disability, and perinatal
• CanMEDS Fellowship competencies (36 LOs, 7 roles): Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional

Beneath those 347 LOs, the PRIMEX index for FRANZCP covers 333 study topics spanning the full Fellowship curriculum. Both the MCQ and MEQ papers draw across this whole spread. Adult general psychiatry is the bulk; subspecialty content (child and adolescent, old age, addiction, consultation-liaison, forensic, intellectual disability, perinatal) appears reliably across most papers.

The highest-yield content areas

From repeated exposure to past papers and the current curriculum, the following topic clusters show up in nearly every sitting. They are worth weighting your study toward.

• Schizophrenia spectrum and first-episode psychosis: diagnostic criteria, positive and negative symptoms, antipsychotic choice, the EPPIC model, clozapine indications, agranulocytosis monitoring, metabolic syndrome screening, treatment-resistant schizophrenia. Expect at least one MEQ per paper to touch psychosis.
• Mood disorders and bipolar: major depressive disorder pharmacology and switching, treatment-resistant depression (augmentation, ECT, ketamine, TMS), bipolar I and II, acute mania, lithium monitoring and toxicity, valproate teratogenicity, perinatal mood disorders. Examiners favour scenarios with comorbidity or pregnancy that force you to weigh competing risks.
• Risk assessment and emergency management: structured risk formulation (likelihood, seriousness, immediacy), suicide risk frameworks, aggressive patient assessment, capacity assessment, de-escalation, involuntary treatment criteria. Risk turns up inside almost every clinical MEQ as a sub-question and is a frequent place candidates lose easy marks by failing to be structured.
• Subspecialty psychiatry: child and adolescent (ADHD, autism, anxiety, eating disorders), old age (dementia, late-onset depression, delirium versus depression versus dementia, capacity), forensic (fitness to stand trial, criminal responsibility), addiction (alcohol withdrawal, opioid agonist therapy, methamphetamine-induced psychosis), perinatal (medication in pregnancy and breastfeeding). At least one MEQ per paper is usually subspecialty-flavoured.
• Psychopharmacology breadth: antipsychotics (typicals versus atypicals, receptor profiles, EPS, QTc, metabolic monitoring), antidepressants (SSRIs, SNRIs, TCAs, MAOIs, switching algorithms), mood stabilisers, anxiolytics and dependence, ECT mechanism and indications, novel and emerging treatments (ketamine, cannabinoids, psychedelic-assisted therapy as outlined in LO 3.38). Pharmacology is testable in every MEQ and is where structured marking points are densest.
• Mental Health Act and medico-legal: involuntary treatment criteria in your jurisdiction (NSW MHA, Vic MHWA, Qld MHA, etc.), capacity, consent, mandatory reporting (LO 3.19), confidentiality limits, duty of care. Examiners reward candidates who name the actual legislation correctly and apply it cleanly to the vignette.
• Cultural psychiatry and First Nations mental health: social and emotional wellbeing framework, cultural formulation in DSM-5, intergenerational trauma, working with Aboriginal liaison and cultural workers, refugee mental health. The curriculum is explicit (LOs 1.5 to 1.7) and these themes are increasingly visible in MEQs.

How the MEQ is actually marked

Understanding the marking schema changes what your written answer needs to look like. Each MEQ part has a discrete set of marking points, often four to eight per part. An examiner is reading down the list and ticking off whether each one appears in your response. Prose flow does not earn marks. Coverage of marking points does.

The implication is structural: bullet-led, clearly headed paragraphs out-perform a flowing essay every time. Examiners marking under time pressure can pattern-match your answer to their schema in seconds. If you have buried the right point in the third sentence of a paragraph, the examiner will probably miss it. If you have used the four headings the schema expects (predisposing, precipitating, perpetuating, protective, for instance) and put the relevant content under each, every point lands.

• Headings beat prose. Use the structural frame the question implies (biopsychosocial, 5Ps, biological/psychological/social management, immediate/short-term/long-term).
• Be specific. "Antidepressant" is half a mark. "Sertraline 50 mg daily, titrate to 100 mg over four weeks" is the full mark.
• Risk formulation is structured. Likelihood, seriousness, immediacy. Static, dynamic, protective factors. Without this scaffolding, examiners cannot find what they are looking for.
• Show working on differential. Naming three differentials with one-line justification each (positive features and what argues against) reads as competent. A single-line "MDD with psychotic features" does not.
• Time per question. 150 minutes for 5 MEQs, including reading, gives roughly 28 minutes per MEQ once you allow 10 minutes for the initial paper-wide read. Walk in with that pacing already drilled.

Common pitfalls that fail competent candidates

The pattern that breaks otherwise capable trainees in this exam is rarely a knowledge gap. It is structural. The clinical knowledge is there, but the answer does not match what the marking schema rewards.

• Vague pharmacology. Naming a drug class without a specific agent, dose, titration plan and monitoring requirement leaves marks on the table. The examiner schema almost always has named-drug, dose, monitoring as separate ticks.
• Unstructured risk formulation. Free-text "this patient has high suicide risk because..." paragraphs cost candidates marks even when the clinical reasoning is sound. Headings (likelihood, seriousness, immediacy, static, dynamic, protective) are not optional.
• No biopsychosocial in management. Pharmacology dominates the answer, psychological intervention gets one line, social and lifestyle gets nothing. The marking schema explicitly rewards all three. So does LO 3.30, the interplay of psychological, social and cultural factors with biological treatment.
• Forgetting the patient. MEQs that probe carer impact, lived experience involvement, cultural safety or recovery-oriented care are penalising candidates who forget those LOs (3.5, 3.7, 3.14, 3.37). These are easy marks once you remember to include them.
• Mishandling pregnancy and breastfeeding. Perinatal scenarios reliably appear. Candidates who default to "stop all medication" or "continue everything" both lose marks. The expected answer balances foetal risk versus untreated maternal illness with named alternatives.
• Mental Health Act vagueness. "Schedule the patient" is not enough. The examiner wants the criteria, the relevant section reference for the trainee's jurisdiction, and the principle of least restrictive care.

Cultural psychiatry and First Nations mental health

Curriculum LOs 1.5, 1.6 and 1.7 sit explicitly in the Foundation Knowledge section and have been reflected in recent papers. The college expects trainees to understand the social and emotional wellbeing framework as it applies to Aboriginal and Torres Strait Islander mental health, the role of cultural liaison and Aboriginal health workers, intergenerational trauma, the cultural formulation in DSM-5, and adapting psychiatric assessment for refugee, migrant and culturally diverse populations.

Practical MEQ-relevant material to study:

• The social and emotional wellbeing model and how it differs in framing from a Western biopsychosocial model
• How to engage interpreters and cultural workers (LO 2.2) and document that engagement
• Cultural formulation interview structure as a clinical tool, not a tick-box
• Specific epidemiology: higher rates of suicide and psychological distress in First Nations populations, contextualised against social determinants rather than presented as inherent
• How to write a culturally appropriate management plan that involves family, kinship structures, and community-controlled health services where relevant

Avoid stigmatising language in any answer, and especially in this domain. Examiners notice it.

Realistic study timelines

Most trainees underestimate the writing component. Knowing the content is necessary, not sufficient. The MEQ rewards trained writing under time pressure, and that takes weeks of practice, not a fortnight.

9 month run-up (recommended for first-time candidates)

• Months 1 to 2 (10 to 12 hours per week): read across the curriculum, working through the 347 Fellowship LOs by stage and area. Stage 1 foundational psychiatry first, then Stage 2 specialty areas. Build study notes or cards as you go. Schedule the lower-yield material (history and philosophy of psychiatry, research methods, CAP statistics) into this early phase so it does not crowd the back end.
• Months 3 to 4 (12 to 14 hours per week): deepen pharmacology and risk formulation. Begin written practice on individual MEQ parts (single sub-question answers under time pressure). Start the past-paper read-through to internalise question style.
• Months 5 to 6 (14 to 16 hours per week): full-length MEQ practice. One MEQ per session minimum, marked against a schema. Move to two MEQs per sitting in the second month. Begin to identify your own pattern of marking-point misses (under-pharm, under-social, under-risk).
• Months 7 to 8 (16 to 20 hours per week): timed full mock papers (5 MEQs in 150 minutes). Aim for one full mock per week minimum. Address weak topic areas surfaced by the mock results. Refine handwriting or typing speed under fatigue.
• Final 4 weeks: taper to two timed papers per week, focus on common pitfalls, reread the 5Ps and risk frameworks until they are automatic. Sleep, exercise, no new content, no all-nighters.

6 month run-up (typical for trainees with strong base knowledge)

• Months 1 to 2 (15 to 18 hours per week): rapid curriculum sweep, prioritising the highest-yield clusters listed earlier. Do not aim for completeness, aim for coverage of the most-examined material.
• Months 3 to 4 (18 to 22 hours per week): structured MEQ practice from week one. Single parts first, then full MEQs. Begin marked feedback (peer, supervisor, AI grader, college study group).
• Month 5: three timed mock papers per fortnight. Each followed by a debrief and a focused study session on the topics that scored worst.
• Month 6: taper, polish, sleep.

4 month run-up (high-risk, only viable with strong clinical base)

• Month 1 (20 to 25 hours per week): curriculum sweep with ruthless prioritisation. Skim what you already know, dwell on weak areas. Start MEQ practice in week three.
• Month 2: two full mocks per week from day one. Marking schema feedback every time.
• Month 3: three mocks per week. Targeted gap-closure between mocks.
• Final month: two mocks per week, taper to one in the last fortnight, sleep priority.

The single biggest mistake people make

You read across the entire curriculum, you build a notes folder that fills three lever-arch files, you can recite the DSM-5-TR criteria for major depressive disorder in your sleep, and you walk into your first practice MEQ at week 16 thinking the writing will look after itself. It does not.

You sit down to a 30 minute clinical vignette about a 24 year old with first-episode psychosis. You write paragraphs. You cover the right ideas. You hand it to your supervisor, who hands it back with a Borderline grade and a comment that says "good thinking, poorly structured for the schema". The marks are not where the knowledge is. They are where the headings are.

The fix is to start writing at week 4, not week 16. Sit one MEQ part per week from the beginning, even when the material is fresh and your answers are short. Get a marked schema back. Watch how examiners pattern-match. Drill the structure, not just the content. The candidates who pass first time treat MEQ writing as a separately trained skill, on its own timeline, alongside content study. The ones who treat writing as the final-month polish learn the hard way that you cannot retrofit structure into knowledge that is already settled the wrong shape.

How PRIMEX helps

• MEQ Grader: the PRIMEX MEQ grader generates authentic FRANZCP-format MEQs with sequential unfolding sub-questions, marks each response using the four task-verb rubric (List, Outline, Describe, Discuss), returns marks per sub with criterion-by-criterion breakdown, and shows a model answer at FRANZCP examiner standard.
• MCQ Practice: Extended Matching Question themed sets mapped to the Fellowship MCQ blueprint. Shared option lists of 7 to 10 items, multiple clinical stems per theme, keyboard shortcuts A through J. Covers 28 psychiatry domains including psychosis differentials, pharmacology, forensic, and perinatal.
• CAP Practice: generates Critical Analysis Problems on demand, each with a synthetic abstract, two data tables, and 4 to 8 sub-questions. Short-answer responses are marked with examiner comments, key points present and missing, and a model answer.
• Curriculum tracker: all 347 Fellowship learning outcomes across Stage 1, Stage 2 (areas A to K), and CanMEDS competency roles are checklisted with progress saved locally, so you can see what you have covered and what still has a gap. MCQ and MEQ activity auto-marks linked outcomes.
• Ask PRIMEX: ask any psychiatry question and get a structured answer drawn from the curriculum mapping, fast enough to use during a study session without breaking flow.

Worked topic deep-dives

Three high-yield topics drawn straight from the PRIMEX FRANZCP study notes. Each one is a teaser; the full note carries the complete assessment, management and MEQ framing.

Schizophrenia spectrum and treatment resistance

The schizophrenia spectrum is unified by core psychotic domains: hallucinations, delusions, disorganised thinking, disorganised or abnormal motor behaviour, and negative symptoms. DSM-5-TR groups these as a single dimensional phenotype.

• Worldwide prevalence is roughly 0.5 to 1 per cent, with life expectancy reduced by about 15 to 20 years from suicide risk and excess medical morbidity.
• Lifetime suicide risk is approximately 5 per cent; comorbid substance use, especially cannabis, is the rule rather than the exception.
• Systematically exclude substance-induced and medical causes of psychosis before assigning a primary diagnosis.
• First-episode psychosis typically presents in late adolescence to early adulthood, earlier in males.

How it is examined: at least one MEQ per paper usually touches psychosis, expecting a structured differential and management. Common pitfall: assigning a primary diagnosis without first excluding substance-induced and organic causes.

Read the full note →

Metabolic monitoring on antipsychotics

People with severe mental illness die on average 15 to 25 years earlier than the general population, with cardiovascular disease the leading cause. Antipsychotics add to that risk through weight gain, dyslipidaemia, insulin resistance and QTc prolongation.

• Metabolic syndrome runs at roughly two to three times the population rate in schizophrenia, and type 2 diabetes at about twice the rate independent of antipsychotic exposure.
• Diagnostic overshadowing means physical complaints are dismissed as part of the psychiatric illness, so monitoring must be systematic.
• The psychiatrist has an ethical obligation to perform baseline and structured longitudinal monitoring and to coordinate intervention across services.

How it is examined: MEQs reward a named monitoring schedule and an integrated physical-health plan, not just drug choice. Common pitfall: diagnostic overshadowing, attributing physical symptoms to the mental illness and skipping the metabolic workup.

Read the full note →

Trauma, grief and child protection

Grief in children is not a scaled-down version of adult bereavement; it is shaped by cognitive development, attachment, family functioning and the social environment. The clinician must separate normative grief from reactions needing intervention.

• Around 5 to 7 per cent of children lose a parent before age 18, and the surviving caregiver's functioning is one of the strongest predictors of the child's outcome.
• Understanding of death evolves: children under 5 may not grasp permanence, while by 6 to 8 years they understand irreversibility and causality.
• Prolonged grief disorder affects roughly 10 per cent of bereaved adults and more after sudden, violent or traumatic death.
• In the Australian context, grief for Aboriginal and Torres Strait Islander young people is often collective, cumulative and intergenerational.

How it is examined: MEQs expect a developmentally and culturally appropriate formulation and a clear line between normative grief and disorder. Common pitfall: applying an adult bereavement framework to a child without accounting for developmental stage.

Read the full note →

Frequently asked questions

Related study guides

• FRANZCOG 2026 Study Guide
• RACP BPT 2026 Study Guide

Not affiliated with the Royal Australian and New Zealand College of Psychiatrists. The RANZCP curriculum and exam structure are the intellectual property of the college; this guide is an independent commentary for trainee preparation. Always check the RANZCP website for current sitting dates, format and policy.