Top Tips from Dr. Barker and Dr. Ilyas for Excelling in MRCP PACES
- July 26, 2024
Preparing for the MRCP PACES can be a daunting task, but with the right strategy and mindset, success is within reach. We are proud to introduce our expert faculty, Dr. Joseph Barker, MRCP, and Dr. Nabil Ilyas, MRCP, who bring extensive experience and a passion for teaching to our program. Having both passed PACES, they have compiled their top tips to help you excel.
1. Understand the Exam Format
The MRCP PACES exam consists of five stations, each designed to test different clinical skills. Familiarise yourself with the structure and timing of each station to manage your time effectively during the exam. Each station is 20 minutes with 5-minute intervals in between.
The stations include:
Station 1: Respiratory and Communication (10 minute, 10 minute)
Station 2: Consultation (15 minutes with 5 minute QA with examiner)
Station 3: Cardiovascular and Neurological System Examination (10 minute, 10 minute)
Station 4: Abdominal and Communication (10 minute, 10 minute)
Station 5: Consultation (15 minutes with 5 minute QA with examiner)
2. Practice Clinical Examinations
Thoroughly Practice as you’re examined. Regularly practice clinical examinations on colleagues, friends, patients, mum & dad or even a pillow. Pay special attention to performing systematic examinations and articulating your findings clearly. This will help you build muscle memory and fluency in your exam technique. Make sure to practice in front of people who make you nervous, that way you get used to performing under pressure.
3. Develop a Structured Approach
Create a consistent and structured approach for each clinical examination. This ensures that you cover all necessary aspects and don't miss key points under pressure. WIPE – Wash your hands, Introduce yourself, Permission, Expose … then inspection, palpation, percussion, and auscultation – look how simple the examination stations are! Same for the history – presenting complaint, patient concern*, history of presenting complaint … past medical history… you know the rest. *Bring up the patient's concerns early so you can shape the consultation around them as people.
4. Refine Your Communication Skills
Effective communication is vital for ALL stations especially consultation and communication stations. Practice explaining medical conditions, treatment options, managing complaints and delivering bad news with empathy and clarity. Seek feedback from peers or mentors to improve your communication style.
5. Master the Art of Differential Diagnosis
Develop a strong foundation in formulating differential diagnoses. There is no substitute for being out on the wards and this really is where the examiner can get the measure of a candidate. For each clinical scenario you encounter, practice thinking through possible diagnoses and justifying your reasoning in a STRUCTURED manner- there is a theme here. Practice out loud, we promise it will help.
6. How to investigate and manage patients
You will have passed MRCP Part 1 and 2. You have the knowledge but PACES tests decision making; you need to know emergency cases thoroughly and have a logical and STRUCTURED approach to care. # Investigations start with bedside investigations, then bloods, then imaging, then special tests. For management patient care is ALWAYS “dictated by degree of severity and patient choice”, whilst management options more often than not “include conservative, medical and surgical options” - these stock phrases buy you time to think of what goes after. Use them.
7. Simulate Exam Conditions
Recreate exam conditions by timing your practice sessions and simulating the exam environment. Nominate an examiner and don’t break character until time is up, however excruciating the line of questioning. This will help you get accustomed to the time constraints and pressure of the actual exam. Consider joining a study group or attending mock exam sessions for added realism. IMG Connect Medicine Facebook group can help you find study partners.
8. Focus on Common* Conditions (*common = common for PACES)
While preparing, prioritise common and high-yield conditions that are frequently tested in PACES. Things that are stable in outpatient but have excellent signs, like dialysis, transplant and congenital heart disease. Ensure you can confidently assess, diagnose, and manage conditions such as COPD, heart failure, stroke, and diabetes. Don’t forget that if a patient doesn’t show up the examiners will go and fish someone from the wards. Keep an eye out for cannulas, wrist bands and drains which can be a clue as to their inpatient status.
9. Seek Feedback and Reflect
Ask anyone that will watch you to give you feedback. Your final exam technique will be the sum of the best titbits from every one of these people, whether they are supervisors, mentors, peers or family. Reflect on your performance, identify areas for improvement, and adjust your preparation strategy accordingly. Continuous feedback and self-reflection are key to ongoing improvement.
10. Balance
Medicine is a marathon, not a sprint. The PACES process, including the months of build-up, is mentally and physically demanding, requiring you to stay focused on your goal for a long time. We all thought PACES was impossible at some point… and now we are teaching it. You will get there but make sure to maintain good health by getting adequate rest, exercise, nutrition and to have fun in the build up to reduce stress and improve stamina.
11. Clinical consultation (CC) station:
Answering patient concerns carries more marks than one can imagine. It is the make or break of the CC station. PLEASE DO NOT wait for the “bell at 2 mins remaining” but start to address patient concerns maybe with 5 mins left on the clock as the patient/surrogate always have follow-up concerns. Many candidates feel that they’ve got the “case” and they feel confident about the station. But they don’t realize that this cardinal mistake has happened leading them to score less than they would have liked.
12. Examination Station
Practice, Practice, Practice on presenting your examination findings in under 2 minutes in an orderly fashion. Everyone knows how to examine an abdomen, everyone knows ascites or a hepatomegaly or what ballot-able kidneys feel like but only a few know ‘how to put it all together’ and present it in a very systematic and neat manner leading to an accurate differential.
Conclusion
Passing the MRCP PACES requires a combination of clinical knowledge, practical skills, effective communication and self-belief. By following these ten tips, you can enhance your preparation and boost your confidence for the exam. Remember, consistent practice, a structured approach and a positive mindset are your best allies in achieving success.
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