MRCP Part 2 PACES Advice

PACES (Practical Assessment of Clinical Examination Skills) is the clinical part of the MRCP exam.

The exam demands:

*Good history taking skills

*Good clinical examination

*Ability to detect the presence or absence of physical signs

*Interpretation of these physical signs

*Good case presentation.

*Making appropriate diagnosis

*Discussion of emergency short term and long management plans

*Ability to communicate clinical information to colleagues, patients or their relatives

*Ability to appreciate the ethical issues that relate to day-to-day clinical practice.

PACES Exam Format

The exam traditionally has five parts or 'Stations' (Some new changes have been proposed which will apply from October 2009, see the link below)

Station 1

* respiratory system examination - 10 minutes

* abdominal system examination -10 minutes

Station 2

Click HERE for detailed MRCP PACES Station 2: History taking Advice

* history taking skills - 20 minutes

Station 3

* cardiovascular system examination - 10 minutes

* nervous system examination - 10 minutes

Station 4

* communication skills and ethics - 20 minutes

Station 5

* Two brief clinical consultation scenarios - 10 minutes each.

(Station 5 will have the most visible changes from October 2009 onwards. Click here to read the changes to the PACES exam format.)

Click here to download some Sample Paces Scenarios

The new Marking System:

Pairs of examiners will continue to assess each candidate at each encounter. They will now award marks to candidates on the basis of their performance on each of seven clinical skills. These skills are:

a) Physical examination

b) Identifying physical signs

c) Clinical communication skills

d) Differential diagnosis

e) Clinical judgment

f) Managing patients' concerns

g) Maintaining patient welfare

How to prepare for the PACES Exam

Apart from keeping your medical knowledge up to date and going through the proposed PACES books, it is imperative to practice history taking and clinical examination skills on patients. One way to do this is to find a patient and see what symptoms he was admitted to the hospital with. You see a patient with who was admitted with chest pain, take history, do clinical examination on him without looking at his chart and come to your own diagnosis. It might take some time for you to get the diagnosis right but practice makes perfect. Take good care of how you communicate with the patient. If you have a colleague with you to check your clinical methods and correct you where you go wrong, that would be even better.

Things you should give emphasis on are:

- correct technique of clinical examination

- recognition of abnormalities

- analysis of these abnormalities

- simple investigation and management

- good communication skills

- good presentation

From the point of view of the communication skills station, ask the patient about what they believe is wrong with them and what do they know about the disease they think they have. What they expect will happen to them. What they think about what caused their condition. What effect does this condition have on their personal and daily life. What do they think is survival from this condition. What other anxieties do they have.

Also pay attention to learning how to deal with different situations relating to patients relatives; how to deal with disgruntled patients and their relatives in different scenarios and how to satisfy or who else to involve if the situation is out of your control.

The number of scenarios in history and communication is endless. It is important to learn the causes of important symptoms in each system, because if you know all the causes it is easy to come up with a differential diagnosis.

Suggested Reading for PACES:

- PACES for the MRCP by Tim Hall - a good but very long book

- Success in PACES - excellent book overall - but not updated for station 5

- 250 Cases in Clinical Medicine by R.R. Baliga - read important cases

- An Aid to the MRCP PACES by Ryder Mir (two volumes) some say outdated but all time favourites with some candidates

- Cases for PACES by Stephen Hoole- Excellent, very short but very concentrated revision book. The new 2010 edition is updated for station 5

- MRCP Paces Ethics and Communication Skills (Master Pass) by Iqbal Khan

- New books for PACES with updated Station 5

OST: Clinical Medicine for the MRCP PACES
Volume 2: History-Taking, Communication and Ethics Excellent book
Iqbal and Mehta

OST: Clinical Medicine for the MRCP PACES
Volume 1: Stations: 1,3 & 5- Core Clinical Skills - Excellent book with updated station 5
Iqbal and Mehta

Revision Notes for MRCP 2 PACES it is worth reading with updated station 5
Shibley Rahman, Avinash Sharma

Some suggest: Some people swear by the new OST Clinical Medicine books

Some suggest: Success in PACES

Others suggest: Paces for the MRCP and An Aid to the MRCP PACES

Clinical Methods Books:

There are several, choose one and read through.

- Clinical Examination by Talley & O'Connor (comes with a basic clinical examination CD)

- Hutchisons Clinical Methods

- MaCleod's Clinical Methods

Useful Websites for PACES Exam

Useful Clinical Examination Videos

PACES Cources

There are specialised courses for PACES available in many countries. These courses can be found online. Famous ones in UK are as below:

- Cardiff paces course




- Fast Paces

- Hammersmith Paces Course

- Lancashire Paces Course

- Kings College Paces Course

- Paces Ahead

- Walton Neurology Course for Paces

- Pastest Course, for PACES

- Guys & St Thomas Paces Course

In the End:

What the examiners are looking for:

1 - correct clinical exam technique

2 - recognition of clinical signs

3 - differential diagnosis and analysis of the physical signs

4 - correct diagnosis,

5 - communication skills

6 - good case presentation and discussion

Do not prepare case scenarios from books. Learn to work on patients from scratch. Work hard. Make it a habit to routinely practice history taking and clinical methods skills on patients in the hospital every day. Keep practicing on patients and you will perfect your skills.

Stage 2 PACES changes (2010/3 diet onwards)

From 2010/3 the new PACES pass standard will be introduced. Candidates will now be required to attain a minimum standard in each of the seven skills assessed AND also attain a minimum total score across the whole assessment. This means that they will have to indicidually pass each Station. Previous passing all Stations was not required as long as your total score was 138/172.

The Clinical Examining Board will review the performance of candidates at their meeting in November 2010 before confirming the pass marks, but the following are given as an indication of likely pass marks for each of the Skills A-G:

Skill Pass Mark
(% of marks available)
A Physical Examination 14 (58.3%)
B Identifying Physical Signs 14 (58.3%)
C Clinical Communication 10 (62.5%)
D Differential Diagnosis 16 (57.1%)
E Clinical Judgement 18 (56.3%)
F Managing Patient Concerns 10 (62.5%)
G Managing Patient Welfare 28 (87.5%)

The required total score will be in the range 124-134 out of 172.


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