Tips for if you fail PACES

How to pass MRCP PACES exam

PACES is a difficult exam and it is not uncommon to fail the first time you sit it. The important thing to do is analyse your MRCP PACES preparation and performance and work out where you went wrong. You can then use this information to be better prepared for the next time you sit the exam.

1. Analyse what happened.

After you fail the exam, do not just jump headlong back into revising, take a step back and review your revision.

Firstly how did you revise? Were you systematic or did you jump around between subjects in your revision? It is tempting to just revise what you saw on the ward that day but it might mean you missed something. Try and stick to a systematic revision plan.

Did you see enough patients? It can be hard to go out of your way to see patients sat at the other end of the hospital especially when you have so much work to do but the extra legwork is worth it.

Did you focus on one station too much? A simple mistake is to focus on the station you are most worried about and spend less time on the one you are confident on. Many friends of mine who failed their MRCP PACES exam passed the station they were most worried about (because of the excellent preparation they put in,) and failed on the one they thought they could do without studying too much.

Did you have a study buddy? These can help you to identify gaps but more importantly watch your presentation technique and help you hone it.

These are some common issues for failing, but everyone is different and you will have your own issues – think about them, talk them though with a colleague and rectify them.

2. PACES will take over your life – just accept it.

You need to plan when  you want/can sit your exam with no distractions. It does take over your life. Did you try and fit in your exam while planning a holiday, taking extra shifts to pay for the holiday or when you just wanted to spend some time on your social life or hobbies? This could be a reason you failed.

To give yourself the best chance of success plan your PACES revision and exam for time when it can take over your life for a few weeks. Accept you might not see your friends for a few weeks – but then this is the next 30-40 years of your professional life for a few weeks of pain. Of course, I recommend planning a holiday or a treat once you have finished – you will have earned it.

3. You are a better doctor for having taken the exam.

Failing anything is not pleasant but the PACES is an exam that works, and doctors are better for having gone through the process. You may have failed at an attempt, but you are a better doctor for having gone through it and as such your are better for your patients.

4. Stay positive

Stay positive! Yes you have failed, and most doctors are not used to failing at pretty much anything academic. However, failure comes to all of us at some points in our lives, and how you deal with it is more important. So, if you have failed then do not despair and work your way through it.  Learn from your errors and mistakes and make sure the next time you do the exam, you give yourself the best chance of success.

Most common neurological conditions that occur in MRCP PACES exams.

Each station in the PACES has cases that occur more commonly than others. This is due to a number of factors that include the number of patients with the conditions, being able to elicit decent clinical signs and create a ‘story’ out of very little history or background information.

Neurology is a much-feared station for many PACES candidates but it is also one of the most passed stations (maybe because candidates are so worried about it they revise it thoroughly).

It can be unnerving and unclear where to start revision as there are so many conditions, but one useful tip is to break down your revision of neurological conditions into the terms of their origin.

These are;

  • cranial nerve;
  • cerebellar;
  • upper limb;
  • lower limb;
  • systemic.

Not only does this instantly make your neurological revision more manageable but can help you  to work out how to examine your patient in the exam. You will never get the whole neurological system as an examination, because it is impossible to do it properly in the time allotted. You will get part of the system, for example upper limb, and even then there is not enough time to examine both motor and sensory function. It is most likely that you will need to examine motor function but do not neglect the sensory system it is something we rarely do properly in everyday practice outside of the neurological field, but one you should definitely re-learn for PACES.

A potential scenario for the neurology station is ‘examine the hand and then go on from there…’ This is typical for the systemic neurological disorders, and there are only a few that fit this area (such as Parkinson’s disease and cerebellar pathologies). So, for example in Parkinson’s, the resting pill-rolling tremor should tell you all you need to know about what to examine.

Common conditions that occur in the lower limbs include peripheral neuropathy, hereditary motor and sensory neuropathy and an abnormal gait. 

Cerebellar pathology usually comes up commonly as cerebellar syndrome, and so you should know all the potential causes.

Systemic conditions include myotonic dystrophy, Parkinson’s disease, hemiplegia, multiple sclerosis and muscular dystrophy.

The main advice for revising and taking the neurological station is break it down into manageable pieces, don’t try and cover everything in the exam (there isn’t time) but do what you need to get the correct diagnosis

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.