MRCP (UK) PACES - a guide for overseas medicine doctors

  • August 19, 2021

PACES is the final exam in the MRCP UK examination series.

Attaining full MRCP UK will facilitate registration with the GMC for overseas doctors, allowing you to secure a job in one of the many medical specialties in the NHS, depending on your experience and specialisation. In this article we will consider the following: 

What is PACES?

The 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 ensures trainees are competent across a wide range of skills and are ready to provide high-quality care to patients.

Am I eligible to sit MRCP PACES?

You must have passed the Part 1 written examination within the last seven years before taking PACES. The Royal College strongly advises trainees to apply after competing two years practical experience and Part 2 of the examination.

What is the content and format? 

PACES is based on a format that is similar to OSCEs, a practical assessment in a clinical setting. There are five clinical stations with either patients with a given condition, or trained stand-ins (surrogates). 

The exam is sat over a half-day and assesses seven core skills over five stations. IMGs can expect eight patient encounters assessed independently by a total of ten examiners (two at each station). 

The seven core skills:

  • Physical examination – demonstrate correct, thorough, systematic, appropriate and professional technique of physical examination.
  • Identify physical signs – identifying physical signs correctly.
  • Clinical communication – elicit a clinical history relevant to the patient’s complaints, in a systematic, thorough and professional manner.
  • Differential Diagnosis – create a sensible, clinically assessed differential diagnosis for a patient.
  • Clinical Judgement – select an appropriate management plan for a patient or clinical situation. Select appropriate investigations or treatments for a patient that the candidate has clinically assessed.
  • Managing patients concerns – seeks, detect, acknowledge and address patients or relatives concerns, confirming their understanding and demonstrate empathy.
  • Maintain patient welfare – treat a patient or relative respectfully and sensitively in a manner that ensures their comfort, safety and dignity.

The PACEs Carousel:

The Carousel consists of five stations, each assessed by two independent examiners. Candidates start at any of the five stations, moving round the carousel at 20-minute intervals, until completed. A five-minute period between each station is given. 

Candidates are marked on clinical skills at each encounter in the examination. An encounter is when a candidate has an interaction with a patient or a surrogate. Stations 2 and 4 involve one encounter, whereas stations 1, 3 and 5 have two encounters. 

How is PACES marked? 

PACES is marked on seven skills, A-G, these are: 

Skill A: Physical examination (stations 1, 3 and 5)

Skill B: Identifying physical signs (stations 1, 3 and 5)

Skill C: Clinical communication (stations 2, 4 and 5)

Skill D: Differential diagnosis (stations 1, 2, 3 and 5)

Skill E: Clinical judgement (all stations)

Skill F: Managing patients’ concerns (all stations)

Skill G: Maintaining patient welfare (all stations)

Skill B, identifying physical signs, is often considered the most challenging skill to pass.

As an overseas candidate, where and when can I take the exam?

It is a little more complicated than Part 1 or 2 exams and exam slots are often in short supply. Whilst the Royal College is working hard to increase the number of spaces, it is not always possible to offer a place to all applicants.

Priority is given to those candidates who are near the end of their stage 2 eligibility period. A full list of examination dates can be found here, please note these are subject to change.

Examination centres are subject to change, so for up-to-date information, please see thr Royal College website here.

The examination is run at clinical centres across the UK (England, Scotland, Wales and Northern Ireland); these vary from diet to diet.

When should I take PACES?

Royal College performance data provides some food for thought when considering when to apply for PACES. The data suggests:

  • Wait at least 36 months after graduation before applying.
  • Those taking the exam before this period were less likely to pass.
  • 24-36 months post-graduation – 50% pass rate
  • 36-48 months after graduation – 77%
  • Candidates that had already passed part 1 & 2 written examinations were significantly more likely to pass PACES at first attempt.

How can I prepare for the exam? 

With lots of resources available online, we have discussed with IMGs the best place to start looking for materials relating to the exams. Most IMGs recommended starting with the Royal College, who have created useful resources to help you to prepare for the exams. See below: 

Curriculum: Applicants are tested on a range of common and important disorders in General Medicine as set out in the Joint Royal Colleges Specialty Training Curriculum for Core Medical Training.

We recommend getting to know the curriculum as early as possible, using it as a road map for your study plan. 

It is recommended that to give yourself the best chance, you gain clinical experience involving care of emergency patients, adults and children.We advise you to regularly invite senior colleagues to observe and provide feedback on your clinical assessments, so you will be comfortable with the PACES format and give you confidence in approaching and examining patients with examiners present.

PACES station 4 examiner guidance examples: This useful guide contains examples of the types of statements found in the examiner guidance section of station 4 scenarios. 

This will help you to understand what the examiner is looking for. 

PACES sample scenarios: These will provide you with the most accurate and relevant scenarios to prepare you for the real thing. Sample scenarios cover Station 2, 4 & 5 (‘history taking’, ‘communication skills and ethics’ and ‘clinical consultations’ respectively.

Most of these have been previously used in a recent exam, but please note that during the exam you will only receive the section marked ‘information for the candidate’.

Videos on what to expect on the day: These helpful videos will give you a true reflection of what to expect on the day of the exam, easing some of the pressure and ensuring you can focus on the task at hand. 

PACES candidate video: Whilst there are lots of useful videos online that are easy to find, the PACES candidate video contains important information about the exam, and practical examples of how the exam will run. 

Candidate guidenotes: these guidenotes created by the Royal College help IMGs to understand what to expect on the day, from your arrival to the completion of the test. 

It can also be useful to understand how IMGs have failed the exam in the past, as this will give you the best chance to pass first time. The ‘how I failed PACES’ guide provides tips to help you to identify where you might be going wrong, along with practical advice to help you to improve. 

For a useful overview of how to prepare for exams, including advice on study groups, online community support, best use of online resources & Royal College materials and courses - take a look at our blogs on exam tips and preparation

Passed? What next? 

First of all, congratulations! After you have passed all parts of MRCP(UK) you can apply for a full registration with a license to practice. Once the GMC have approved your application, you can work as a doctor in the UK. 

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