MRCP PACES examination format

PACES carousel
You will be marked at each of the five clinical stations, assessed by two independent examiners.
You can start at any one of the stations and move to the next every 20 minutes until you have completed the cycle. There is a 5 minute period between each station.

Carousel of MRCP PACES stations

MRCP PACES Skills

	Clinical Skill	Skill Descriptor
A	Physical Examination	Demonstrate correct, thorough, systematic (or focused in Station 5 encounters), appropriate, fluent, and professional technique of physical examination.
B	Identifying Physical Signs	Identify physical signs correctly, and not find physical signs that are not present.
C	Clinical Communication	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.
D	Differential Diagnosis	Create a sensible differential diagnosis for a patient that the candidate has personally clinically assessed.
E	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.
F	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.
G	Maintaining Patient Welfare	Treat a patient or relative respectfully and sensitively and in a manner that ensures their comfort, safety and dignity.

Different numbers and combinations of skills are assessed at each encounter, as per the table below:

Station	Encounter	Skills Assessed
1	Respiratory	A:B:D:E:G
1	Abdomen	A:B:D:E:G
2	History	C:D:E:F:G
3	Cardiovascular	A:B:D:E:G
3	Nervous System	A:B:D:E:G
4	Communication	C:E:F:G
5	Station 5 (1)	All seven
5	Station 5 (2)	All seven

MRCP PACES Mark scheme

You will be assessed by ten examiners, two at each of the stations. For each of the eight encounters they will complete a marksheet assessing a combination of skills.
Each is graded Satisfactory (2 marks), Borderline (1 mark) or Unsatisfactory (0 marks).
Examiners will review the patients at stations 1, 3 and 5 to establish the criteria for a satisfactory grade. This is known as calibration.

MRCP PACES: Patient encounters

An encounter is an interaction with a patient or surrogate. Stations 2 and 4 involve one encounter, whereas stations 1, 3 and 5 have two encounters.
There are therefore a total of eight encounters throughout the exam organised into stations:

Station	Encounter	Duration of examiner-to-candidate contact	Download sample scenarios
1	respiratory system examination abdominal system examination	10 minutes 10 minutes
2	history-taking skills	20 minutes	Station 2 example scenarios
3	cardiovascular system examination nervous system examination	10 minutes 10 minutes
4	communication skills and ethics	20 minutes	Station 4 example scenarios
5	integrated clinical assessment brief clinical consultation 1 brief clinical consultation 2	10 minutes 10 minutes	Station 5 example scenarios
	Total time	125 minutes (including 5 minutes between each station)

MRCP PACES: Stations 1 and 3

These are known as the “physical examination” stations. The emphasis in these stations is on the:
1. demonstration of a comprehensive and correct physical examination technique
2. ability to detect physical signs
3. ability to construct a differential diagnosis
4. ability to suggest sensible and appropriate treatment and investigation plans
5. ability to treat a patient with dignity and respect.
Before seeing each case, you will receive written instructions as to what is required for example:
Example of written instructions to the candidate at the cardiac station: This 45-year-old woman is thought to have a heart murmur. She is short of breath on exercise. Please palpate and auscultate her heart, and tell the examiners what signs you find, and discuss your proposed management. The station structure is that;
1. 10 minutes are spent with each patient
2. for each case, a maximum of 6 minutes are allowed for the physical examination, followed by a minimum of 4 minutes for questioning from the examiners.
You will be expected to differentiate the normal from the abnormal appearances of the optic fundus.
Examiners and candidates are reminded that the inclusion of a normal optic fundus in Station 5 is permissible.

MRCP PACES: Station 2

The history-taking skills station aims to assess the candidate’s ability to:
1. gather data from the patient,
2. construct a differential diagnosis,
3. deal with concerns the patient may have,
4. construct a management plan that is explained to the patient clearly, and to treat the patient with dignity and respect.
The station features:
- written instructions for the case, usually in the form of a letter from the patient’s GP are given to the candidate during the 5-minute interval before the station
- 14 minutes are allowed for the history-taking, followed by a 1-minute period of reflection followed by 5 minutes for discussion with the examiners
- the two examiners are present throughout observing the interaction with the patient.

MRCP PACES: Station 4

The communication skills and ethics station aims to assess your ability to:
1. guide and organise the interview with the subject (who may be a patient, relative, or surrogate, such as a healthcare worker)
2. explain clinical information
3. apply clinical knowledge, including knowledge of ethics, to the management of the case or situation
4. provide emotional support
5. treat the patient with dignity and respect.
The station features:
- written instructions for the case are given to the candidate during the five-minute interval before this station
- 14 minutes are allowed for the patient interaction, followed by 1 minute to reflect, followed by 5 minutes for discussion (after the patient has left the station).

MRCP PACES: Station 5

The integrated clinical assessment station aims to assess the way in which the candidate approaches a clinical problem in an integrated manner, using history-taking, examination, and communication with a patient or a surrogate.
The station features:
- written instructions for each of the two cases, usually in the form of short notes or referral letters are given to the candidate during the 5-minute interval before this station
- for each case, 8 minutes are given with each patient to take a focused history, carry out a relevant examination, and respond to the patient’s concerns. Two minutes are for describing the positive physical findings and to give your preferred diagnosis and any differential diagnosis (after the patient has left the station)

MRCP PACES Sample scenarios

Station 2 and 4 and sample scenarios
- Most of these sample scenarios have previously been used in the examination. They are no longer suitable for use in the real exam because they are out of date, too technical, or have been used for a long time previously. The sample scenarios will give you an idea of what happens during the exam at Stations 2 and 4, but please note in the actual examination, you will only receive the section marked ‘Information for the candidate’.
- Sample scenarios for Station 2 (history taking) (16 Scenarios)
- Station 4 (communication skills and ethics) (24 Scenarios)
Station 4 examiner guidance examples
- This document has examples of the types of statements found in the examiner guidance section of Station 4 scenarios.
- These indicate what examiners would like you to demonstrate in different types of scenarios.
Station 5 sample scenarios
- Station 5 scenarios are created by the host centre for real patients. This ensures that the scenarios are a reflection of the everyday practice of candidates. The sample scenarios will give you an idea of what happens during the exam at Station 5. In the actual examination you will only receive the section marked ‘Information for the candidate’.
- Sample scenarios for Station 5 (brief clinical consultations) (9 Scenarios)
- For more details on how to pass you can look at some advice from examiners.

Why is the MRCP PACES examination of 2020 being changed?

Postgraduate medical education has undergone significant changes in the ten years since the current MRCP(UK) Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills), commonly known as PACES, was introduced.
The new Internal Medicine Curriculum, Shape of Training and other reviews have helped us to better understand the competences required of doctors in the 21st century.
The changes to PACES are the product of a 12 month review of the examination by MRCP(UK) to ensure that it remains fair, relevant and fit for purpose.
- The changes build on the current format but develop some elements to make them more realistic for examiners and trainees. It now better reflects the new Internal Medicine stage 1 curriculum, developed by the JRCPTB on behalf of the Federation of the Royal Colleges of Physicians.
- The curriculum, implemented in August 2019, is designed to produce doctors with the generic professional and clinical capabilities needed to manage patients presenting with a wide range of general medical symptoms and conditions and holistic decisions on progress will be made for high level capabilities in practice.

What is being removed in the MRCP PACES examination of 2020?

Station 2: The history-taking station was considered to be artificial with structured history-taking skills being tested in isolation and not representative of modern practice.
Station 4: 20 minutes for a single communication and ethics encounter was felt to be rather long and in particular, the five-minute examiner/candidate interaction added little value to the overall assessment.
Station 5: Testing all seven skills in an integrated manner was very like real life but was very pressured in 10 minutes.

What is being introduced in the MRCP PACES of 2020?

Communication: Two 10-minute communication encounters. These will no longer include a question and answer section with the examiners. Instead, the encounter will be judged on observation alone.
Consultations: Two 20-minute clinical consultations will assess candidates across all seven skills in a realistic and integrated manner. Candidates will have 15 minutes to take a structured history, examine the patient, explain the likely diagnosis and management and address any questions or concerns raised. There will then be a five minute question and answer section with the examiners.
Encounter sequencing across the carousel: The new carousel will alter the sequencing of the encounters through the carousel. Some stations will include physical examination and communication encounters. This will ensure that examiners at each station contribute more judgements in each of the skills for each candidate, improving the reliability of the exam.