Pass MRCP PACES | Coping with nervousness

Being nervous prior to your PACES is normal.  Very few candidates get through this exam without their pulse rate picking up, and fear taking hold.  You should expect this to happen, and rather than trying to avoid feeling nervous focus on managing your stress levels.

This article provides simple stress management tips that we and others have found invaluable in sitting their PACES exam:

  1. Avoid caffeine – many people have a benign tremor while nervous, which caffeine will exacerbate.  If you feel like you have an obvious tremor, that can feed on your nervousness and make you feel more nervous.  Plus, you’re extremely unlikely to be feeling sleepy during your exam due to your stress levels!

2. Arrive early – this exam is stressful enough without you having to contend with additional stress caused by risking being late on account of a traffic jam or other travel disruption.

3. Imagine you’re back in the skills lab – you’ve done these routines hundreds of times before.  Experienced clinicians deal with stressful situations such as cardiac arrest calls by imagining they’re on a course working on an actor or a mannequin.  If you imagine during your PACES exam that you’re back in a skills lab practising your routines you’ll feel a whole lot less nervous.

4. How to make eye contact with a terrifying examiner – making eye contact is a sign of confidence, but can be daunting if you have an examiner who appears displeased with everything you say!  Look at the bridge of their nose in between their eyes, instead of at their pupils.  They won’t be able to tell, and you’ll find it a lot less intimidating.

5. Regulate your breathing – nervous people tend to either hyperventilate, which exacerbates a sense of panic, or alternatively hypo-ventilate – which can make your voice crack and cause you to sound nervous.  Learn what you are more prone to when stressed, and compensate for it.  But not too much.

6. Don’t second guess how you’re doing – and don’t be put off by a station that seemed to go disastrously.  The history of PACES is littered with candidates who have passed a station but decided that it went badly – then panicked and impaired their chances in the following stations!  Forget about what has already happened and focus on what is still under your control, which is the stations you’re about to sit.


8. Then speak – many people when nervous try to compensate by talking too much.  Judicious use of pauses to consider a question and gather your thoughts makes you come across as sensible, thoughtful and calm.

9. Act confident – even if you don’t feel confident, by pretending to be confident you will elicit a whole bunch of behaviours that will reduce your nervousness.

10. If you don’t know the answer to a question, that’s fine.  Just admit it, and tell the examiners that you’ll definitely cover it in your reading after the exam.  Being prepared to admit to not knowing a particular point is more confidence-inspiring for examiners than seeing you flounder and getting caught.