Revision strategy

Many candidates wonder how to prepare for the MRCP PACES examination.  It can be hard to know where to start – after all, this is a test of clinical skill and acumen.

The first thing to recognise is that it is not possible to revise for this examination exclusively by doing online banks of MCQ’s, or from a book.  There are innumerable candidates who mistakenly conclude that because this tried and tested approach worked for their part I or part II they should stick to the same proven formula.

Wrong.  In fact, very wrong.

PACES measures a different type of knowledge.  Although some basic factual knowledge is essential, this is not really what PACES is designed to test.  If you have passed the part I and part II, you already have 80-100% of the knowledge you need under your belt. PACES tests all those qualities of being a good doctor that just can’t be answered with a Google search or from a book.  For example:

• The ability to elicit, interpret and contextualise clinical signs;
• Displaying empathy;
• Demonstrating good judgement in ethically challenging scenarios;
• The ability to think on the spot;
• Confidence;
• Efficiency.

So how should you prepare?

Priority one: Practice

Then practice some more.  And then practice again.

For many PACES candidates, modern clinical medicine – with it’s ready access to CT and echo – has relegated the importance of clinical examination to a cursory afterthought.

You must put that behind you and learn to maximise the value you get from examining a patient. Not only because it will help you pass the PACES but because you will be a much better doctor.

Examine your friends.  Examine patients who are well.  Examine patients who are ill.  Examine your relatives.  Examine your partner, or your sibling, or your parents. Work on your examination routines until you don’t have to give a nanosecond’s thought to what you’re doing and are focusing solely on deciding whether you can identify a clinical sign or not. PACES is tough.  

You don’t want to be spending your brain power on what to do next in your clinical examination of the patient.  You need to be thinking about what you’re going to tell the examiners.

Priority two: Experience

Expose yourself to clinical signs and scenarios. Doctors taking the MRCP PACES need to discern normal variation from abnormal pathology.  

Just as modern investigations have hampered doctors’ ability to thoroughly examine a patient, they have also damaged their ability to interpret what they’re hearing through a stethoscope.

Are you a doctor (there are many) who got in the habit of hearing a potentially abnormal heart sound and just booking an echo? You need to get over that.

You need to be able to discern aortic stenosis from mitral regurgitation with total accuracy.  

But it doesn’t stop there.  

To really boost your chances you need to recognise a VSD, a 3rd heart sound, a 4th heart sound and an ASD.  You need to be able to not only identify a renal transplant but be able to provide a likely explanation about why your patient had it in the first place.  And perhaps, speculate about what immunosuppressant they’re taking based on related clinical signs.

Section conclusion

There are only really two vital elements to passing your PACES:  

Practice, and experience.  

You have the knowledge already.

We can’t practice for you.  That’s all down to you.  

But we can turbocharge your ability to get the experience.

Clinical Skills Pro subscribers get access to our online HD multimedia course containing huge numbers of heart sounds, lung sounds, rare syndromes, JVP abnormalities (yes, all of them!), Dermatome Dave, and much more besides.  

Immerse yourself in a database of HD video recordings of clinical signs that you’d never encounter on a single traditional weekend course.  

Gain access 24/7.

Rewind and revisit.

And then pass.

Skills for the MRCP PACES

What does PACES assess?

The exam is designed to appraise your abilities in a range of skills that can’t be readily tested in a written exam.

MRCP PACES courses

I’ll be 100% straight with you here:

I’m not exactly impartial when it comes to MRCP PACES courses.

I’m one of the editors in chief for the Clinical Skills Pro “Pass your MRCP PACES” revision course.

So what follows is my opinion.  Which could be seen by some as biased.

So here are my opinions

1. Going on a course is not 100% necessary to pass MRCP PACES.  You can definitely clear the exam without it.
2. But they are extremely helpful, and do improve your chances.

There are two “flavours” of course out there.  You can do neither, one, or both.

Completely free

Of course, the best option of the lot is to get all your experience and practice on the wards by arranging practice sessions with your colleagues.

Get your consultants, registrars and colleagues who have recently sat the exam to take you around interesting cases.

Dress and decor

I’m not going to tell you what to wear on your exam day, just general principles to adhere to.

The examiners will be asking themselves the ultimate MRCP PACES question:

Would I trust this doctor to run my hospital at night, when I’m not there?

You need to look like an appropriate sort of person to fit those requirements.  That means you need to look:

• Smart
• Professional
• Hygienic
• Sober
• Bare below the elbows
• Not bare above the knees!

Very few candidates fail to achieve these minimum standards.

All that said, you are being tested on your clinical skills not whether you can afford an Armani suit.

PRO TIP: No one will care or dock you points just for looking nervous.  However, candidates have occasionally lost points for being over-confident or “cocky”.

If you fail

First up: Don’t despair.

I know, failing is a horrible feeling.  But you’re in good company.  Tons of great doctors attempt MRCP PACES and don’t clear it first time.

Unfortunately on this occasion you got unlucky.  It’s an exam that can have a random element to it, sometimes, that can catch even the best doctors out.

I’ve failed PACES – and then went on to pass it.

Sometimes in life you just have to deal with setbacks.  

Take a short break, then:

• Look carefully over your exam feedback to figure out how you can develop for a repeat attempt
• Focus on developing skills you might be weak in
• Consider further revision courses or materials that you haven’t used yet

Conclusion

First up, I’d really like to thank you for taking the time to read this guide to MRCP PACES.

I want this to be the most useful guide on the internet.  So if you think I’ve missed something, I’d be really grateful if you could reach out to me using the “Feedback” tab on the edge of your screen, or by emailing me at [email protected]

Just let me know what you think should be added.

And if you liked it – I’d be very happy if you could share this on social media with your colleagues who might like to read it.

I hope you’ve found this helpful in setting you on the right path, and given you a clear idea about what to expect.

All that remains is for me to wish you the very best of luck in your exam!