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.

GOOD LUCK!

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..

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!!!!!

18 essential tips for PACES you need to know

At Clinical Skills Pro the process of preparing and going through the MRCP PACES examination can be a nerve-racking experience. We know we’ve been through it ourselves. Apart from ensuring that you have the learnt all the clinical knowledge you can there are some practical things you can do to ensure you are in the right frame of mind to sit your exam.

1. Register early. Demand for sitting the MRCP PACES is high, and spaces are limited. By registering early you can plan your revision to fit the exam schedule and reduce the risk of missing out on getting your desired time slot;

2. Start revising early. Typically four to six months of hard work is required to prepare adequately. Although some pass with less preparation time, don’t risk it. We recommend starting as early as possible on practising, rehearsing your presentation skills and reviewing common clinical conditions found in the MRCP PACES examination;

3. Check the regulations. Available at the RCP website;

4. Carry your admission documents. Print out your admission documents and carry them in a document folder on the day of your exam for reference;

5. Plan your route. Either book a taxi for the morning of the exam or plan ahead very early – particularly if you have to get to the exam venue in rush hour;

6. Be prepared. Your exam will not be in the same town as where you work. Expect to travel. Ideally travel down a day ahead and stay in a hotel or B&B the night prior to your exam to reduce the risk of travel disruption;

7. Be very prepared. Don’t just bring one set of exam clothes and shoes. In case of disaster or mix-up, bring two;

8. Avoid alcohol the night before. Sure, you’ll be nervous but don’t impair your chances by turning up with a hangover;

9. Go to bed early the night before. By this point in the run up to your exam, a good night’s sleep is going to be more use to you than a couple extra hours spent cramming;

10. Avoid too much caffeine on exam day. Some people get a tremor with excessive caffeine that can be exacerbated by nervousness. You want to minimise the extent to which you appear nervous so consider cutting down on the coffee;

11. Dress conservatively. What does this mean? Generally candidates should wear clothing similar to what would be expected on a ward. This may include being bare below the elbow and nothing too likely to alarm your grandmother;

12. Arrive early. Get to your exam venue at least an hour before your exam start time;

13. Declare your equipment. Show the host any special equipment you hope to use before your exam – for example amplifying digital stethoscopes need to be tested by the examiners on the patient before you use them to determine what is fair to expect you to pick up clinically;

14. Bring photo ID to your exam. For most people this will be a passport or driving licence. More details about what is permissible can be found here;

15. Leave valuables behind. Most exam centres will offer a secure room for your phone and valuables, but to be safe it is inadvisable to bring large amounts of cash. Take just enough as a contingency for a taxi and refreshments;

16. Mark sheet madness. While you’re waiting to start you’ll be given 16 mark sheets. Be prepared to enter your examination number, name and centre number on each one in the time prior to starting;

17. Chat to other candidates. Once you’re in the exam centre you will still have a large amount of time before being called to start. This will be a lot less painful if you can take your mind off things by chatting with the other candidates than if you sit ruminating on everything that can go wrong;

18. Plan a treat for yourself after your exam such as some annual leave or time with family. You’ll be able to sustain more revision if you have something enjoyable on the horizon when it’s all over;

All these things help make the day of your PACES exam run smoothly so you can concentrate on showing how good your clinical skills are.

PASS MRCP PACES: Exam Overview

At Clinical Skills Pro we know that the MRCP PACES is the final and toughest part of the postgraduate examination series you must pass to gain entry to the prestigious Royal College of Physicians.  It is designed to test the clinical knowledge and skills of junior doctors who hope to enter higher specialist training in hospital medicine, and forms one of the hardest obstacles on the path to becoming a hospital consultant.

Aside from being a necessary career hurdle, passing the MRCP is a prestigious professional award with international recognition as a marker of clinical excellence.

Walking into the exam room for the first time can be daunting. In this we are discussing what the examiners will be looking for in your presentation on each station.

1.

Physical examination: Demonstrate correct, thorough, systematic (or focused in Station 5 encounters), appropriate, fluent, and professional technique of physical examination

2.

Identifying physical signs: Identify physical signs correctly, and not find physical signs that are not present.

3.

Clinical communication skills: Elicit a clinical history relevant to the patient’s complaints, in a systematic, thorough (or focused in Station 5 encounters), fluent and professional manner.  Explain relevant clinical information in an accurate, clear, structured, comprehensive, fluent and professional manner.

4.

Differential diagnosis: Create a sensible differential diagnosis for a patient that the candidate has personally clinically assessed.

5.

Clinical judgement: Select or negotiate a sensible and appropriate management plan for a patient, relative or clinical situation.  Select appropriate investigations or treatments for a patient that the candidate has personally clinically assessed.  Apply clinical knowledge, including knowledge of law and ethics, to the case.

6.

Managing patients’ concerns: Seek, detect, acknowledge and address patients’ or relatives’ concerns.
Listen to a patient or relative, confirm their understanding of the matter under discussion and demonstrate empathy.

7.

Maintaining patient welfare: Treat a patient or relative respectfully and sensitively and in a manner that ensures their comfort, safety and dignity.

This is what the examiners are expecting of you. It is not just a case of knowing all the physical signs of the condition but being able to interact empathetically and professionally with the patient and the examiners.