MRCP PACES – the ultimate guide [updated 2019]

 

Hi there.

In this guide you’re going to learn everything you need to know to clear MRCP PACES.

So set aside ten minutes, grab a coffee, get rid of distractions.

And get ready to go.

The first step is the easiest and fastest: Start by signing up for my mailing list to get your hands on free revision materials.

About your author

Dr Edward Banham-Hall MRCP PhD

Dr Edward Banham-Hall MRCP PhD

Consultant physician

I passed my MRCP PACES over ten years ago, but I can still remember the mix of exhilaration and terror during my exam.  Since then I’ve organised MRCP PACES for other candidates, and trained thousands of doctors to clear this exam.

 

Despite the extremely stressful nature of this exam I have seen how candidates’ clinical skills improve and develop as they prepare.  

 

I’ve written this post to produce what I wish I’d had: An easy to read, comprehensive guide that sets out in plain English everything you need to know and prepare.

Why take MRCP PACES at all?

 

I’m going to be completely honest with you.  This is a totally fair question.

Let’s be clear – this exam is:

  • A lot of hassle
  • Extremely stressful
  • Very expensive
  • Difficult

 

Then, if you do pass, you get to launch into your new life as a medical registrar on call. 

Lucky you. 

You now get to stay up all night and run your hospital.  You’re the doctor everyone turns to for advice.  You’re the final (awake and physically present) port of call for anything medical that comes through the door.

If taking this exam seems like hassle, wait until you see what becomes of your career when you’ve passed it…

 

So why bother?

Well – there are a bunch of good reasons why you’d put yourself through this exam.  Here are some of them.

 

It will make you a better doctor.

I promise.  This exam makes hone your clinical skills so that you can quickly and reliably reach a diagnosis.  You’ll do your job better as a result, and you’ll provide your patients with better care.

 

An internationally recognised badge of quality.

Wherever you are on the globe, possession of the MRCP qualification provides instant evidence of your calibre as a physician and your ability to provide high quality care to your patients.

 

You don’t have a choice.

In many countries you’ll remain a very junior doctor forever without passing MRCP.  Your career is sooner or later going to grind to a halt if you don’t take this exam.

 

 

Planning for your MRCP PACES

So you’ve decided to go ahead with your exam.

Good choice.

Here are my tips for how you should set about it:

Tip #1 – learn from others

An extremely large number of doctors have taken MRCP PACES over the years.  The MRCP tracks attempt numbers and pass rates, and recommend the following predictors of PACES success:

  1. Candidates who make their first attempt at MRCP part 1 within 12-24 months of graduating
  2. Candidates who make their first attempt at MRCP part 2 within 36 months of graduating
  3. Candidates who don’t take MRCP PACES until after 36 months of graduating fare better 
  4. Candidates who pass the MRCP part 2 written before attempting PACES.

Of course, these are not hard and fast rules.  

Just trends that tell you a lot about this exam:

A certain amount of real-world clinical experience and practice with patients helps you pass.  Clear your written (knowledge) exams first, then finish up with PACES.

Tip #2 – plan ahead

You can check out the current MRCP PACES and fees right here.  Some centres book up really early.  

Have a think about when you’re likely to want to take this exam.

Avoid predictable major life events if possible:

  • Getting married
  • Childbirth

You’ll need to be completely focused on revising – and that might involve working antisocial hours, or in your free time.

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.

Exam format

Your PACES exam works as a carousel of five different stations that each test varying skills required of a proficient doctor.

You could start at any of the five stations, and you’ll work your way around patients at each one.

Each station lasts a total of 20 minutes, and you have 5 minutes before each station – for some stations (that’s stations 2, 4, and 5) you should use this time to read the candidate brief provided.

There are always 11 examiners, who are hospital consultants and senior hospital doctors. Your encounters will consist of a mix of real patients and actors.

The examiners take turns to ask the candidates questions – so for any given encounter in your exam you should expect one examiner to usually remain silent and the other to direct your discussion.

Check out this video from the Royal College of Physicians to learn more

9 minutes duration.

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.

Skill A: Physical Examination

You need to be able to examine a patient in a slick, methodical, technically correct fashion.

In stations 1 and 3, that means completing your clinical examination within 6 minutes.  Station 5 is less clearly defined in terms of timing – you need to complete a focused and relevant examination – while you complete obtaining the history.

Candidates who do badly here tend to lose points because of:

  • Not examining in a systematic fashion
  • Using incorrect techniques
  • Missing things out
  • Hesitancy
  • Examining a patient through their clothing
  • Examining in an unprofessional manner

Skill B: Identifying Physical Signs

It’s no use conducting the slickest, most comprehensive clinical exam ever if you miss the pathology.

Failing to identify clinical signs is one of the commonest reasons to fail PACES.

You also need to present your findings in a calm, confident and clear manner to your examiners during the discussion that follows.

Candidates often failure because:

  • They miss clinical signs examiners agreed on during calibration
  • They report clinical signs that are not present

 

Skill C: Clinical Communication Skills

You have to be able to communicate clearly with a patient to:

  • Get an accurate history
  • Address their ideas, concerns and expectations.

Your ability to do this is assessed in stations 2, 4 and 5.

In your PACES exam you will need to:

  • Elicit important information
  • Provide accurate and clear information to your patient
  • Avoid jargon
  • Speak courteously and professionally to your patient

Skill D: Differential Diagnosis

You’ve got “double jeopardy” here.

What does that mean?

If you fail to identify physical signs (Skill B) you’ll lose points on differential diagnosis also.

To get points in this domain you need to:

  • Provide a reasonable differential diagnosis
  • Consider the correct diagnosis
  • Avoid providing a long list of “textbook” differentials which would not be likely to apply to the patient in front of you

 

Skill E: Clinical Judgement

You’ve got “double jeopardy” here too.

This domain reflects your ability to make a sensible plan.

That includes:

  • Investigations
  • Management of your diagnosis

Candidates who get the correct diagnosis usually pass this domain too.  

Get the wrong diagnosis, and you’ll lose points here also.

Skill F: Managing Patient Concerns

Think “ICE”.

  • Ideas
  • Concerns
  • Expectations

You need to demonstrate that you have asked the patient (or their representative) if they have any questions and answer them in an accurate and sympathetic manner.

Then confirm that they understand.

Skill G: Maintaining Patient Welfare

It is possible to pass every station, but fail the PACES exam entirely if you don’t get this right.

You need to treat your patients with dignity and respect.

To be clear, failing on Skill G is uncommon – candidates can fail here by:

  • Being disrespectful
  • Acting in an insensitive fashion
  • Not ensuring patient comfort
  • Causing pain
  • Endangering patient safety

MRCP PACES books

How do you start revising for MRCP PACES?

Pretty well all candidates use a book.  Or perhaps if their exam is some way away they might even consider buying two. So you’re probably going to need to do the same.

First there is one very important caveat.  Relying on books to pass the MRCP PACES is a really big mistake.

Spending time practising with patients and gaining exposure to real clinical signs is far more important and must occupy the vast bulk of your efforts.    

But we do recognise that sometimes a book is exactly what you need to consolidate your practice and help you target your revision towards those conditions which come up often in the MRCP PACES.   Or just while you’re sat on the bus.

What you almost certainly do not want to do is spend £482.50 of your hard-earned cash buying all fifteen of the currently in-press books for sale to candidates taking the MRCP PACES.  And then rupture an aneurysm trying to lift them onto your shelf.

So find out which MRCP PACES books best fit your personal use-case from our post here – with concise companions starting from only £9.99.

We’ve done our very own meta-analysis of over 200 reviews found on the internet and aggregated them into this one convenient page summarising opinions about each book’s strengths and weaknesses.

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.

Online courses

These do not involve transporting patients to a hospital so that junior doctors can line up and examine them.  These reduced costs are passed on to their subscribers.

Attendance courses

These courses bring PACES candidates, faculty, administrators and patients to the same location, incurring significant expense.  

 

Cheap

These do not involve transporting patients to a hospital so that junior doctors can line up and examine them.  These reduced costs are passed on to their subscribers.

Expensive

These courses bring PACES candidates, faculty, administrators and patients to the same location, incurring significant expense.  

£

£££££

Easy to access / low intensity

Online revision permits you to access bite-size revision from the point you subscribe through beyond your exam day.

Short lived / high intensity

Spend between one and four days cramming your way around patients during your weekend or study leave.

Better exposure to patients

The Clinical Skills Pro online course provides you with over 300 full length patient cases.  There’s no doubt that’s way more than you’ll ever see on an attendance course.

Better practice

If you need to practice how to examine a patient, ultimately you can’t do that online.  You do need to pick up your stethoscope and place it on people.

  • Cases
  • Carousels
  • Quizzes
  • Physical practice
  • Cases
  • Carousels
  • Quizzes
  • Physical practice

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.

Logistical planning

There’s not much point missing your exam through poor planning.  Or arriving at the last minute because you got stuck in traffic.

Taking your MRCP PACES is stressful enough without adding to it.

Here’s what you need to plan well in advance:

  • Accommodation
  • Travel to your exam centre
  • A taxi ride on the day to and fro
  • Transport home

You’ll also need to bring stuff with you to your exam centre on the day:

  • Stethoscope
  • Ophthalmoscope
  • Identify documentation
  • Pen and pencil

Pack your bag ahead of time and use a checklist.

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”.

When You Arrive At Your Exam

So your big day is here.  You should:

  • Arrive in plenty of time
  • Fill in your mark sheets with your name and candidate number (this takes some time while you’re waiting to go in)
  • Turn your mobile phone off
  • Declare any special equipment you’d like to use, for example electric stethoscopes
  • Try to stay calm, but don’t worry if you can’t

While you’re doing all this the examiners will be busily calibrating what they judge to be reasonable expectations for each patient.  They’ll examine the patients themselves and agree what clinical signs candidates should detect.

During the exam itself

You’ll kick off by sitting outside your first station for five minutes.  If there’s a candidate brief, then read it.  Carefully.  If you were expecting one, and can’t find it – ask.

Then get ready to go in and assess your first patient.

If you don’t understand an examiner’s directions – ask.

The stations are all structured slightly differently, but all add up to 20 minutes in duration. Here are the timings:

Station 1

Respiratory system

  • Six minutes to examine your patient
  • Four minutes to present your findings to the examiners and engage in discussion

Abdominal system

  • Six minutes to examine your patient
  • Four minutes to present your findings to the examiners and engage in discussion

Station 2

History taking skills

Five minutes to prepare before entering the station.  Then once called inside:

  • 14 minutes to interview your patient (your examiners will give you a 2 minute warning before your time runs out)
    • Warning: You have to sit in silence if you finish early!
  • 1 minute to gather your thoughts 
  • 5 minutes to present your findings and answer the examiners’ questions

 

Station 3

Cardiovascular system

  • Six minutes to examine your patient
  • Four minutes to present your findings to the examiners and engage in discussion

Neurological system

  • Six minutes to examine your patient
  • Four minutes to present your findings to the examiners and engage in discussion

Station 4

Communication skills and ethics

Five minutes to prepare before entering the station.  Then once called inside:

  • 14 minutes to interview your patient (your examiners will give you a 2 minute warning before your time runs out)
    • Warning: You have to sit in silence if you finish early!
  • 1 minute to gather your thoughts 
  • 5 minutes to present your findings and answer the examiners’ questions

 

Station 5

Before starting this station you will be provided with two sets of short written instructions (“scenarios”) and will have five minutes to read them both.

CLINICAL SKILLS PRO TIP: Be warned.  This is the most time-pressured of all stations.  You must ensure you have practised keeping to the timings below and are familiar with the pace this requires.

 

Brief clinical encounter 1

  • Eight minutes to take a brief history from your patient and conduct a focused clinical examination
  • Two minutes to present your findings to the examiners and engage in discussion

Brief clinical encounter 2

  • Eight minutes to take a brief history from your patient and conduct a focused clinical examination
  • Two minutes to present your findings to the examiners and engage in discussion

Clinical Skills Pro Bonus Tip

 

Commonly, candidates feel a station has gone badly because of how they perceive an examiner has reacted.

Then they panic.

Then they screw up the next station.

Sometimes they go on to fail the exam, but find out they’d passed the station they were worried about, and failed the next one because they were panicking about a station which had been fine all along!

I have seen this happen to several excellent doctors.

It is imperative you avoid a PACES “downward spiral”. 

Do not:

  • Try to guess the examiners’ reactions
  • Ruminate on previous stations – it’s outside your control as soon as the encounter is over
  • Decide you have already failed while the exam is ongoing

You must:

  • Give every station your best shot
  • Put completed stations out of your mind as soon as the encounter ends
  • Maintain a professional demeanour until you have left the hospital your exam is in

When it’s all over

The worst of it all is over now.

And your fate is almost entirely out of your control – your last task is to maintain a professional demeanour until you’ve left the exam centre completely.

Here’s what you should expect:

  • You won’t receive any feedback on the day, so don’t ask
  • You shouldn’t communicate with any candidates arriving at the exam centre – this is a breach of the exam regulations
  • Make your way home

Now it’s time to relax, or allow yourself a treat.

You’ve earned it.

You’ll get your results really pretty quickly:

  • UK candidates will have their results no later than 10 working days after their exams
  • International candidates will have results released no later than 15 working days after their exam date

You can’t collect your results from the RCP,  except via their website portal once they’re released.

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

 

If you pass: Congratulations!

Welcome to the Royal College of Physicians!

You’re now part of an elite, historic and prestigious professional organisation comprised of some of the best physicians on the planet.

I’m not going to tell you how to celebrate, because I figure you can come up with your own ideas for that.  But I do recommend you go to your RCP admissions ceremony if you’re able to. 

It’s a great evening.

What I’d love, though, is if you take just a second to let me know if you found anything on my website helpful in getting you through.  And if you used any of the Clinical Skills Pro resources (free or paid) just reach out using the “Feedback” tab on the edge of your screen to let me know if you’ll join my “Roll of Honour”.

Well done!

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!

Dr Edward Banham-Hall MRCP PhD

Dr Edward Banham-Hall MRCP PhD

Consultant physician

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