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Putting you through your PACES — 20 essential facts about the updated clinical examination for physicians

Published on: 20 Dec 2023

MRCGP Clinical Skills Assessment

The Federation of the Royal Colleges of Physicians of the UK (RCP, RCPE and RCPSG) has introduced an update to one of its membership examinations – PACES23.

 

1. What is the new PACES exam?

PACES (Practical Assessment of Clinical Examination Skills) is designed to test the clinical knowledge, skills and attitudes of trainee doctors, many of whom hope to enter higher specialist training for physicians in the UK. The examination sets rigorous standards to ensure doctors are capable across a range of essential clinical skills and professional activities. It has recently been updated (PACES 23).

 

2. When would you typically take the PACES exam?

In the UK, directly after graduation from medical school, the first step of training in medicine is two years of foundation training in a UK hospital. Sometimes this term is shortened to FY1 or FY2 (for Foundation Year). An FY doctor is in their first postgraduate training post. Most UK candidates take their MRCP(UK) Part 1 examination toward the end of this training period.

 

3. How does PACES contribute to an MRCP(UK) Diploma?

The diploma is the official certificate confirming that you have successfully passed all three parts of the MRCP(UK) diploma examination:

Successful completion of the entire three-part examination is required before you can start specialist physician training in the UK.

 

4. What is the format of the new exam?

Five clinical stations are set up in a clinical setting (hospital or clinical skills centre) to create an examination carousel. At each station there is either a patient with a known clinical condition, or a trained stand-in (surrogate). You will spend 20 minutes at each station, working clinically and interacting with the patients/surrogates (these are known as encounters) while being assessed by two independent examiners. In total there are eight encounters (since some stations have more than one). You’ll get a five minute break between each station.

PACES23 Carousel [square]

 

5. What skills are assessed?

The examiners will evaluate seven key skills: physical examination; identifying physical signs; clinical communication; differential diagnosis; clinical judgement; managing patients’ concerns; maintaining patient welfare. You are required to conduct a respiratory, cardiovascular, neurological, and abdominal examination in addition to demonstrating your communication skills.

 

6. How long does the exam take?

125 minutes (including 5 minute breaks between stations).  

 

7. Why has PACES 23 been introduced?

The old PACES was changed to reflect changes in postgraduate medical education, training and assessment, as well as the workplace.

 

8. What is the difference between this new exam and the old format?

There are now two communication encounters instead of one (stations 1+4), where examiners observe and assess 10-minute interactions with patients/surrogates. Two new assessments have also been introduced (stations 2+5) where candidates have 15 minutes to undertake a clinical consultation (obtain a detailed history, conduct a physical examination and identify clinical signs, plus advise on management) before they are questioned by the examiner. Station 2 used to test history taking without a physical examination – this was considered rather unrealistic and has been modified to include a physical examination. There used to be a 20 minute station dedicated to a single communications and ethics encounter — this was considered too long.

 

9. Is the standard the same?

Yes. The standard of the examination remains the same - set by the three Royal colleges: Royal College of Physicians, Royal College of Physicians of Edinburgh, Royal College of Physicians and Surgeons of Glasgow.

 

10. What requirements do you have to meet to take the exam?

You must have passed the Part 1 written examination before taking PACES. It is advisable to have at least 2 years’ clinical experience working in hospitals after you have received your primary medical qualification.

 

11. When will the new exam format be implemented in the UK?

The exam was implemented worldwide in September 2023 with the exception of Singapore where it will commence in the first diet of 2024.

 

12. What is the turnaround time on results?

Between 3-12 weeks. Average turnaround time: 8 weeks.

 

13. How do you apply?

You can apply via your MRCP online account.  You will need details of your training and work history for the last 12 months including hospital names and addresses; dates of courses; and dates of any previous examination attempts. If you want to apply to take the examination at a centre outside of the UK you can find out how to apply by watching this video.

 

14. How much warning will you get before the exam date?

4 weeks — admission documents, containing your allocated examination date, time and location will be sent a minimum four weeks in advance of your examination date.

 

15. How much does it cost?

£657 in the UK.

£1202 at an international centre.

 

16. What is the pass rate?

The average pass mark for all candidates is 54%. See Pass rates.

 

17. What happens if you fail?

You can apply for a provisional place to resit the examination (at specific centres only). If you secure a provisional place but pass your exam, your provisional application will be automatically removed. You will not be required to pay for a provisional place until you have a confirmed seat.

 

18. Can I get help to practise for PACES?

Yes. MRCPUK has some written scenarios.  You can also get help passing the exam at BMJ’s examination support platform OnExamination which has an AI revision tool for the PACES exam. This tool will enable you to practise your consultation skills at patient simulation stations and receive personalised feedback. Sign up here.

 

19. What happens when you pass?

You will receive a results letter and be invited to attend an admission ceremony hosted by the college of your preference. A list of upcoming ceremony dates can be found on the MRCPUK website.

 

20. When you’ve passed PACES are you automatically a member of a Royal college?

If you’ve passed all three parts of the MRCP(UK) Diploma then you are well on your way. But you also need to complete a ‘Form of Faith’, which confirms you are of good professional standing and agree to uphold the specified standards of professional development and conduct of the Royal Colleges of Physicians.