by Mie Thu Ko
The PACES (Practical Assessment of Clinical Examination Skills) exam is one of the most challenging exams every medical trainee has to face in their life! It is the practical component to the MRCP(UK) examination, which is designed to test the clinical skills and knowledge of trainee doctors aspiring to enter HST (Higher specialist training) in the UK. It is one of the three essential exams that need to be completed in order to obtain the full MRCP diploma. If you are an Internal Medicine Trainee (IMT), you are expected to have completed it by the end of your second year. Although it can be quite challenging, with the right strategy you should be able to ace the exam! This article is designed to give to an idea about the exam, how to apply for it and what to expect on the day.
1. What is PACES?
PACES is the practical component to the MRCP(UK) examination. It is different from the MRCP Part 1 and Part 2 written exams in that it takes place in a clinical setting and you have to interact with real patients with relevant symptoms and signs. Rigorous standards have been set to ensure competence in a range of clinical skills. The 7 clinical skills assessed in PACES exam are physical examination, identifying physical signs, clinical communication, differential diagnosis, clinical judgement, managing patients’ concerns and maintaining patient welfare.
To pass the exam you need to achieve a pass mark in each of these 7 domains, as well as a total mark of 130 and above to pass the exam. Even if the total mark is greater than 130 but one of the skills is not passed, this would be classed as a fail overall.
2. PACES 23
PACES23 is the new exam format which is going to be introduced from August 2023. Full details of these changes can be found on the MRCPUK website, but we will outline these below:
Figure 1: PACES Carousel (Old Format), Source:mrcpuk.org
Figure 2 : PACES 23 Carousel, Source:mrcpuk.org
As you can see, a few changes have been introduced to the PACES carousel. The main changes are:
1) Removal of the history taking station.
2) The 20-minute communication station has been replaced by two 10-minute communication stations. In this new format, there will be no longer be allocated time for questions with the examiner at the end of the communication station.
3) The brief clinical consultation stations have now been removed in favour of two 20-minute consultation stations; which will also assess all seven skills, but candidates are given a longer time to complete this in the new formal. During the initial 15-minute period, candidates will be asked to take a history, examine the patient, explain the likely diagnosis and management and address any concerns raised by the patient. This will be followed by a five-minute question and answer section with the examiners.
3. Who is eligible to sit PACES?
To sit PACES, you must:
1) Have a GMC-recognized Primary Medical Qualification
2) Have passed Part 1 written examination within the last 7 years before taking PACES.
It is advised by MRCP(UK) that you have at least 2 years of clinical experience following receiving your Primary Medical Qualification. In addition, it is not necessary to pass the Part 2 written examination to be eligible to sit PACES.
However, data on the MRCP(UK) website suggests that pass rates are highest when candidates pass the Part 2 written examination before attempting PACES and delay the PACES exam until 36 months after graduating from medical school.
Of course, the decision about when to sit PACES is absolutely yours and you can decide to make an application whenever you feel like it. But make sure that you have enough clinical experience before PACES, because this makes such a difference and you will find that it gets easier as you have more clinical experience. Even if you want to attempt PACES without having recommended experience, make sure that you join a PACES practice group at your hospital and make the time to examine LOADS of patients.
4. How to apply for PACES and exam fees
The current exam fee for PACES is £657 in the UK and £1202 internationally. You can apply online through your My MRCP(UK) online account. Before you start making an application, make sure that you have details of your work history (i.e. hospital names and addresses) available for the last 12 months. PACES exams run three times a year in three ‘diets’, which usually are:
1) January- March
Applications usually open around 8-10 weeks before the actual assessment period; it is always worth checking out the website for the application window period so that you won’t miss it. If you are applying at an international centre, please make sure you check the MRCP(UK) website as the application period may be slightly different.
5. After making an application
After making an application, you will receive an automated email that your application has been received. The decision regarding your application will be received within 2-3 weeks after the application window. If your application has been accepted, you will get an email notification confirming the date, time and location of your exam.
6. Exam day
The day of your PACES exam is the most important day in your PACES journey. Make sure you arrive at the test centre according to the time stated on your admission document.
If the exam centre is far away, consider booking a hotel to stay the night before; your study budget should cover this (including travel). If you decide to travel to the exam centre on the day of the exam, make sure you plan ahead and factor in any potential delays which may occur.
Ensure that you dress appropriately in a smart and professional manner. As you will be examining patients, it is better to avoid tight, restrictive or excessively flowing clothes which may make it difficult for you to examine.
Ensure that you bring your admission document and photographic ID with you on the day (this is usually a UK driving licence or passport). You should also bring a bottle of water and a snack with you; some centres provide refreshments for candidates but this isn’t guaranteed.
Once you arrive at the exam centre, you will be taken to the waiting area. Also bring a bottle of water with you and a snack in case you get hungry. You will then be given a briefing by the chair of the exam and will then be taken in to sit the exam.
7. After your exam
You have now completed your PACES exam! Now it is time to take a well-earned break. Make sure you give yourself plenty of time to rest, de-stress and enjoy. (And try not worry about what happened in the exam!)
For UK centres, examination results are available within 3 weeks after your exam. For international centres, results are available between 4 to 6 weeks after your exam.
Once the results are available, you can see the breakdown of your marks on your online My MRCP account. If you wish, you can also ask for the written feedback sheets from the examiners by emailing the PACES team.
Whilst PACES can be a scary experience, with the right preparation, you will be able to tackle it easily. I will provide some exam tips and tricks in future articles. I hope this gives you an insight into the exam and what to expect.
Wishing you all the best for your PACES exam!