MRCP PACES exam stations overview

There are five MRCP PACES exam stations in each carousel. Each station lasts for twenty minutes with a five minute changeover time between stations. Overall you will be in your exam for approximately two and a half hours, so it is important to be aware that you will be need to be completely focused for that length of time.

At each of the MRCP PACES exam stations two consultant examiners will be observing your consultation, taking notes then testing you with a small number of questions at the end.

So not only do you need to have all your medical knowledge ready, but you need to concentrate for a couple of hours while you have the constant presence of two consultants judging what you do.

I mention this because I want you to remember this not just an exam that can be passed or failed on your knowledge, but how you keep your cool under pressure.

Prepare yourself for this and don’t be caught by surprise!

Clinical Skills Pro MRCP PACES exam stations

So let’s look at each of the MRCP PACES exam stations more closely and learn our top tips for passing each one!

MRCP PACES exam stations stethoscope

MRCP PACES exam stations – 1 – respiratory and abdominal examinations

Here you have two separate ten minute tests of your ability to examine these systems and correctly identify clinical signs, including a minimum four minute discussion with the examiners about your findings.

  • Top tips for passing
    • Respiratory – make sure you clearly look for extraneous signs in the face and hands for clues to the diagnosis (such as a yellow nails with bronchiectasis or a heliotropic rash in dermatomyositis and pulmonary fibrosis). Also look around the bed area for other clues like inhalers (for the far more common COPD patients).
    • Abdominal – do not to forget to palpate at every level of the abdomen i.e. on your knees; otherwise you are not properly examining and don’t forget to palpate and observe the inguinal regions in case there are any renal transplant scars – you do not want to say it is a normal abdomen and miss the most obvious diagnosis.
  • Station two – history taking skills. This consists of a single twenty minute consultation with an actor (they are usually very convincing) in which you are examined in your ability to take a history, form a differential diagnosis and make a clinical plan while addressing the patient’s concerns.
  • Top tips for passing
    • remember to let the patient or relative talk
    • remember to ask about herbal medicines and over-the-counter medications as well as recent changes in doctor prescribed medications and allergies
    • there are dozens more tips on our interactive video here —-> History & Communication revision video
MRCP PACES exam stations history taking
MRCP PACES exam stations cardiology neurology
  • Station three – cardiology and neurological examinations. Here you have two separate ten minute tests of your ability to examine these systems and correctly identify clinical signs, including a minimum four minute discussion with the examiners about your findings.
  • Top tips for passing
    • Cardiology – during the auscultation do not forget to sit the patient forward and listen in expiration in the left lateral position otherwise you might miss the regurgitation murmur.
    • Neurology – you do not have enough time to do an entire neurological examination (and you will not be expected to) so do the part of the exam that is most pertinent to your patient.
  • Station four – communication skills and ethics. This station assesses your ability to guide an interview with a patient, family member or other individual while communicating clinical information and applying your knowledge of ethical considerations to a given scenario.
  • Top tips for passing
    • Listen to your patient/relative, don’t assume anything and empathise with their situation.
    • Again have a look at our history and communications video —->History & Communication revision video
MRCP PACES exam stations communication skills
MRCP PACES exam stations brief clinical encounter
  • Station five – integrated clinical assessment. This station is the newest component of the PACES examination, and puts you under some time pressure.  You must take a brief focused history, conduct a targeted physical examination (at the same time), and identify and respond to patient concerns – all in eight minutes!  In the remaining two minutes you need to summarise your findings to the examiners and propose a plan.
  • Top tips for passing
    • You are against the clock! This is the part of PACES where you have to be the most efficient.
    • Practice your examinations until you can do them correctly without thinking. Once you start your station 5 exam you can concentrate on doing the most important parts and getting to a diagnosis without worrying about whether you are doing it right.

Top tips for the discussion

At the end of each of the MRCP PACES exam stations there is time for the examiners to ask you questions. One thing that I have observed when coaching people through their exam is that candidates do not volunteer information.

Remember:  Whatever question the examiners ask you should expand your answers and volunteer information. The worst thing you can do is wait to be asked – the examiners may assume that anything you don’t say you don’t know. For example, if you are giving a diagnosis or differential expand your answer and explain how you would exclude each of these. Besides, there is only a short amount of time for this part of the exam.  The more you talk about what you know there is less time for the examiners to potentially ask you a question that you don’t know the answer to.

I hope this post outlining the MRCP PACES exam stations has helped.  However, always remember:

The examiners have one question that they are asking of you, the ultimate PACES question.

MRCP PACES exam stations trust

The Clinical Skills Pro course goes into each of these MRCP PACES exam stations in depth helping you to be prepared for your exam day.

The examiners meet briefly after you depart to discuss the exam progress, and may already have a clear idea about whether you have passed or failed.  However, you will have to wait a number of weeks to find out how it went while the RCP conducts a moderation exercise across centres to ensure fairness and consistency.