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.

Ways you could fail MRCP PACES | No. 1

All the doctors at Clinical Skills Pro have passed their MRCP PACES exam so we know how tough it is to pass and how easy it is to fail. You can know every clinical sign under the sun but make a simple error in your patient examination and it is all over. This is the first way you could miss an important clinical sign.

Yes the underpants of death can actually make you fail your PACES exam.

In the abdominal station one of the key clinical scenarios you must practice and learn about is renal transplant and the associated complications. However, as many renal transplants are placed in either the left or right iliac fossa, and the examiners will deliberately make sure any underpants will be covering this if you do not check below the waistline (while also maintaining the patient’s dignity and not exposing everything), then you will miss the telltale scar and palpable mass, miss the diagnosis, and fail.

So always remember to not fall prey to, the underpants of death!!!!!