UPSC CMS Exam Analysis 2020–2025

Paper I is split between General Medicine and Paediatrics. Medicine has historically carried 75–80% of Paper I, but 2024 and 2025 show a deliberate rebalancing toward Paediatrics:

The shift is significant: Paediatrics went from roughly 1-in-5 Paper I questions (2020–2023) to nearly 1-in-3 in 2024–2025. Candidates who under-prepare Paediatrics relative to Medicine are taking on more risk than in previous years.

Paper II splits across Surgery, Obstetrics & Gynaecology, and PSM. This was remarkably stable at roughly 40/40/40 from 2020–2023, but 2024 and 2025 broke that pattern sharply:

PSM weightage jumped from a steady 33% (2020–2023) to 42–43% in 2024–2025 — the single biggest structural shift across all six years of papers. This likely reflects UPSC's increasing emphasis on public health, National Health Programmes, and epidemiology given their direct relevance to a Medical Officer's field role. OBG weightage fell correspondingly. Candidates preparing primarily from older (pre-2023) paper patterns risk under-allocating study time to PSM.

One measurable proxy for difficulty is the share of "consider the following statements, which is/are correct" format questions — these require knowing multiple facts simultaneously rather than recalling a single answer, and are widely considered harder than direct one-line MCQs.

The trend is unambiguous: multi-statement questions more than tripled from 2020 (18%) to their 2022 peak (58%), and have since settled into a new normal of roughly 48–53% from 2023 onward. In practice, this means close to half of every modern CMS paper requires you to evaluate 3–4 individual claims correctly, not just recognise one right answer among four options — a meaningfully higher bar than the 2020 paper presented.

UPSC drops a question from the final answer key when its options are found ambiguous, factually disputed, or the question is later judged outside the syllabus — all credited candidates receive marks regardless of their chosen option. Across six years and 1440 questions, only 4 have been dropped, a dispute rate under 0.3%, indicating UPSC CMS question quality has been consistently high. The 2025 paper had the most disputes (2), including one Medicine question (extrapyramidal system clinical features) where the official key was later shown to be medically inconsistent with the correct answer.

Total question count per subject across all 1440 questions and 6 years. This is the most reliable guide to where your preparation time should go.

Medicine + PSM together account for 55.4% of the entire paper. A candidate who masters just these two subjects can clear the cut-off even with average performance across Surgery, OBG and Paediatrics.

Chapters ranked by total question count across all 6 years. These are the chapters that have consistently contributed the most to the paper.

UPSC CMS is fundamentally a clinical reasoning exam, not a recall exam. Understanding question style helps you prepare the right way.

Percentages overlap because some questions combine types (e.g. a clinical scenario in EXCEPT format). The key implication: practising single-fact flashcards alone prepares you for less than 15% of the paper. Case-based reasoning practice from PYQs is essential.

Bottom line for 2026: Allocate a small but non-zero chunk of revision time to Psychiatry and Toxicology — both are rising from a low base and a few well-targeted questions can meaningfully improve your score. Do not spend time on standalone Anatomy, Physiology or Biochemistry questions — these have almost completely disappeared from the modern CMS paper.

1. Gastroenterology and Endocrinology dominated 2021–2023, but Cardiology and Pulmonology have taken over as the top Paper I topics in 2024–2025 — a clear shift worth weighting your revision toward.

2. PSM has become the single largest Paper II subject in the two most recent papers (2024, 2025), overtaking its historical equal-thirds split with Surgery and OBG.

3. Obstetrics has overtaken Gynaecology as the more-tested OBG sub-topic since 2023, after Gynaecology led in 2020–2022.

4. Multi-statement questions are now the norm, not the exception — practising single-fact recall alone will leave you underprepared for roughly half the paper.