PASS MRCP PACES: Behind the scenes

A clear understanding of what goes on behind the scenes during PACES is actually very helpful for your preparation.  This post describes how the MRCP PACES exam is administered and run, providing valuable insight into how patients are picked for your exam day.

Consultants, usually from UK hospitals, act as examiners and are unpaid and often giving up their own free time.  There is usually single organising consultant from the host hospital who organises the exam on the day and ensures everything (hopefully) runs smoothly.

This consultant will often delegate certain responsibilities for the exam to a medical registrar who will organise many of the patients and some of the admin on the day.  That person is probably running around dealing with unexpected glitches, and is likely to be quite stressed.

Patient databases

Because exam centres host PACES repeatedly each year, they work from patient databases of willing volunteers with clinical signs – particularly for stations one, three and five.  What this means in practice is that patients appearing in these stations will usually fit one of the following categories:

  1. Patients with chronic illnesses and stable clinical signs who are able to attend the exam centre repeatedly;
  2. Patients with clinical signs of shorter duration who are current inpatients, but are well enough to transfer to the exam centre for several hours at a time.

For the same practical reasons, self-evidently acutely unwell patients at risk of clinical deterioration will not be present on the day.  For example, you are very unlikely to see a patient with acute left ventricular failure, pneumonia or a bleeding duodenal ulcer – even though such things are commonly seen on the general medical take!

Structured mark sheets

Examiners are quite constrained in how they can assess you.  Although horror stories may abound of people failing for having the wrong haircut or wearing their stethoscope around their neck while presenting their findings, these are fictitious.  You can download the mark sheets the examiners have to score you by here.

The ultimate PACES question

Despite the structured mark sheets, at the back of each examiner’s mind is the ultimate PACES question:

Would I trust this candidate to work as my medical registrar and run my hospital at night?

If you can persuade enough of them that you are a safe pair of hands, one way or another you’ll be OK..