How to prepare for PACES/MRCP Part 2 (Clinical Exam)

Tuesday, February 22, 2022

The MRCP (UK) Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills - PACES) is designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialist training (ST3). The exam sets rigorous standards to ensure your competence across a range of skills and you are ready to provide a high standard of care to patients.

The majority of doctors we have spoken to and MRCP general trends in data for the highest pass rates suggest that passing the Part 2 Written Examination before attempting PACES is favourable.

Who is eligible to sit PACES?

You must have passed the Part 1 written exam within the last 7 years before taking PACES                                            

What is the format of the exam?

You are assessed on your ability to carry out essential clinical skills. In this half-day examination, you go to a clinical setting and visit five stations where there are patients with a given condition. At each station, there will be two independent examiners who will observe and evaluate your performance based on seven core skills.

Stations 1, 3 and 5 have two encounters and 2 and 4 involve one encounter meaning a total of eight patients will be seen. Before seeing each case, you will receive written instructions as to what is required. An allocated amount of time is then spent with each patient for each case, followed by a set time with questioning from the examiners.

Is this format affected due to COVID-19?

Yes. MRCP(UK) continues to closely monitor COVID-19 infection rates and the impact this may have on upcoming PACES exams. Consequently, there have been some changes to the format. Stations 1, 3 and 5 will retain the existing carousel format, using real patients and assessing the same seven skills as before. The time at each station will remain the same but additional time will be added between clinical encounters for changes to PPE and any items to be thoroughly cleaned.

What about the other two stations?

Stations 2 and 4 along with a 20-minute rest period will form another 3-station mini-cycle. This will run in the same centre on the same day as the original mini-cycle. These stations will be run remotely.  You will interact with the patient or surrogate via video link, and your questioning from the examiners will also be via video link. Many of you will have become familiar with telephone and video consultations since the start of the Covid-19 pandemic. The skills required are the same as for face to face consultations, but the remote nature of the consultation means that you may need to modify your approach.

How much does it cost?

At the time of writing this article, the assessment is priced at £657.

How do I register?

UK PACES spaces are prioritised for UK trainees; any remaining places are then allocated to non-UK trainees on a first-come-first-served basis. Apply through your My MRCP(UK) account and late applications are not accepted.

Applications open for one week, three times a year. The assessment period is then finalised and will be confirmed in the following weeks, exam dates can fall on any day during the three-month assessment period for your application including weekends. Admission documents, containing your allocated examination date, time and location will be sent a minimum of four weeks in advance of your examination date.

How to revise for PACES

How can I prepare?

Whilst books and question banks will have supported you through MRCP Part 1 and 2, PACES is all about practical assessment and clinical examination. The best preparation for PACES is lots of practice. Picking up physical signs is crucial. Tell your supervisor that you are sitting PACES, find the consultant within your hospital who are PACES examiners or registrars who have passed PACES recently. Form a group with other doctors who are sitting their PACES exam so you can share patients and practice delivering your findings out loud. This process won’t only enable you to pass PACES but provide you with confidence in your examinations, thoughtful when diagnosing and clear in your communication with patients and colleagues. 

Which skills are assessed? 

  • Respiratory
  • Abdominal
  • History taking
  • Cardiovascular
  • Neurological
  • Communication skills and ethics

You can read more in-depth information about the station structure and combination of skills being assessed here

Time

The more time you have to study for a test, the more confident you will be on exam day. When preparing for PACES, the rotation you are in throughout your training is more important since you need to be able to find time to practise the practical skills. Doctors who have previously passed PACES have said that a rotation in A&E is less than ideal because of the fast-paced environment, the fact that you are often assessing patients and then handing them over to another team without seeing the outcome, and the unsocial shifts that make it difficult to find people to present your diagnosis and findings to. It's generally agreed that practising in medical or ward-based rotations, when you encounter patients during the day, is easier.

Additional resources for remote stations 2 and 4

Royal College of General Practitioners shares 10 useful tips for doctors doing virtual consultations. You can read the article here.

Top tips for revision

  • Find other trainees who are practising for PACES so you can practice the examinations together, you can (without breaching confidentiality) share patients and assess one another.
  • Try and plan your preparation around a quieter rotation where you will have time to practice standing on the spot and presenting your findings. Typically, something like an A&E rotation would allow less time for this.
  • Focus on picking up physical signs in your patient examinations as this will help you on the day. 

Resources

Rcgp.org.uk. 2022. Top 10 tips for successful GP video consultations. [online] Available at: <https://www.rcgp.org.uk/about-us/rcgp-blog/top-10-tips-for-successful-gp-video-consultations.aspx> [Accessed 22 February 2022].

Mrcpuk.org. 2022. PACES examination format | MRCPUK. [online] Available at: <https://www.mrcpuk.org/mrcpuk-examinations/paces/paces-examination-format> [Accessed 22 February 2022].

Mrcpuk.org. 2022. How to apply | MRCPUK. [online] Available at: <https://www.mrcpuk.org/mrcpuk-examinations/paces/how-apply-0> [Accessed 22 February 2022].

Mrcpuk.org. 2022. UK PACES COVID-19 | MRCPUK. [online] Available at: <https://www.mrcpuk.org/mrcpuk-examinations/paces/uk-paces-covid-19> [Accessed 22 February 2022].

Mrcpuk.org. 2022. [online] Available at: <https://www.mrcpuk.org/sites/default/files/documents/How-I-failed-PACES.pdf> [Accessed 22 February 2022].