How to pass MRCP PACES

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.

We recommend starting by signing up for our mailing list to get your hands on free revision materials.  Then reading on.



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.


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.