How to pass MRCP PACES

How to pass MRCP PACES exam

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.


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.

5 mistakes doctors make when revising for MRCP PACES

With so much to learn for your MRCP PACES exam it is easy to make some mistakes in planning your revision. Avoid these and you will be better prepared on the day of your exam.

1. Avoiding the neurology station
Neurology to many medical students and young doctors can appear to be a ‘dark art’ and one that is to be avoided at all costs. Unless you want to become a neurologist, then for many, it is a subject that can appear, initially to be quite difficult. However, do not let this put you off. Not only is neurology a fascinating subject, but once you have learnt a few techniques for understanding how to classify the neurological system, it does not become that hard. So do not avoid it, embrace it!
2. Not practicing history station because you do it everyday and know how to take a medical history
This is a common issue (see the next top tip to fail as well). You are a doctor, you take a medical history everyday, so why do you need to practice it? Well, the simple answer is, (and I can tell you this from experience in training many doctors to go through PACES,) that you have bad habits and you do not take a proper medical history. The PACES is a performance where everything is done ‘by the book’ and this includes the history. So practice it as much as any other station, because you do not want to fail because you took a bad history.
3. Not practicing communications skills because that is also something you do everyday and know how to do, right?
Wrong. Again, you get into bad habits, and once you start practicing, you will find that you do a lot of the following: talk over the patient; not allow enough time for them to digest the information and generally be too fast. A lot of this comes from doctors having heard most of the responses and trying to reassure the patient. Let the patient talk, give them time, and PRACTICE. Again, failing because of the communications station is not pleasant.
4. Focusing on the complicated, rare conditions
Focusing on primarily the rare conditions is a sure-fire way to fail. You have to know about some rare conditions, but also, do not forget that common conditions happen commonly. In a later blog post we will go over the top conditions covered in the MRCP PACES exams.
5. Not practicing presentation skills
Presentation of your findings is an important part of your PACES exam and verbal diarrhoea is common with nervousness. Again I will go over some presentation tips in a later blog post but in the meantime practice your presentation skills with a friend and get them to (honestly) give you feedback.


The main thing to remember is practice everything, repeatedly and don’t leave anything to chance. Even the aspects of your clinical examinations that you find easy or feel confident about.

What you need to know about the MRCP PACES examiners.

There are 11 of them and only one of you, and they determine your success or failure.  But who are they?

For candidates sitting MRCP PACES in the UK (and most other places around the world) the examiners are a collection of senior hospital consultants.  Their motivation is seeing the next cadre of hospital doctors trained to an adequate standard – and that includes being able to competently examine a patient.

As a minimum, PACES examiners have held a CCT in a medical specialty for at least two years prior to starting as an examiner, and be working in a substantive post.  They need to be active clinically and involved in general medicine.

The other requirements include clinical supervision of core medical trainees in general medicine and having undertaken equality and diversity training in the last three years.

Your examiners will all have completed a day-long training course to ensure reproducibility and fairness, and are encouraged to examine at least 30 candidates per year – a process that will usually take two or three days.

For each station you will have two examiners, who will take it in turns to lead with asking you questions or observing and taking notes.  Each examiner marks candidates independently, without knowledge of what scores the other examiner is assigning.

So what does the 11th examiner do?  You are likely to not even meet them – their role is to troubleshoot during the examination cycle, collate and check marksheets and compile the candidate performance summaries.  In most cases, the host examiner acts as the 11th examiner.

Ways you could fail MRCP PACES | no.2

The eyes of disaster? Really I hear you say? 

Well, this is where you are asked to examine the eyes, and fail to realise that one of them is prosthetic. So, check the red reflex of both eyes – are they both real? You will look incredibly daft, and fail, if you attempt fundoscopy on a patient with a prosthetic eye.

Pass MRCP PACES | Coping with nervousness

How to pass MRCP PACES exam

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.