A Comprehensive Guide To Acing MRCP PACES

Have you completed your MRCP Part 1 and MRCP Part 2 written? Congratulations, you deserve a pat on the back! You are officially at the last hurdle to enter a higher specialist training (ST3+ level and above) in the United Kingdom (UK). All you have to do is clear the MRCP PACES.

But for people who are new to MRCP (UK), here is what the exam is about.

MRCP (UK) is a postgraduate qualification awarded by the Royal College of Physicians (RCP) that guarantees a route towards General Medical Council (GMC) registration. The diploma ensures that all medical physicians in the UK are held to the same high standard. Upon completion, it allows you to work at the ST3+ level.

The MRCP exam series is divided into two parts: Part 1 and Part 2, with Part 2 further divided into a computer-based theory exam (also known as MRCP Part 2 Written) and the Practical Assessment of Clinical Examination Skills (PACES).

PACES, also known as MRCP Part 2 Clinical, is a practical exam designed to test your clinical skills and knowledge. It takes place in a hospital-like setting that includes 8 encounters at 5 stations.

This blog offers a comprehensive guide to the MRCP PACES exam, covering everything from structure and skills to preparation and tips. Let’s dive in!

What is the eligibility for MRCP PACES? 

To be eligible for MRCP PACES, you need to have completed Part 1 in the last seven years. If more than seven years have passed, you need to retake the exam to be eligible for MRCP PACES.

The MRCP UK website also advises completing at least 2 years of clinical experience after receiving your primary medical qualification and finishing MRCP Part 2 Written. However, these are not a requirement to be eligible for PACES. 

What is the structure of the MRCP PACES Exam?

The MRCP PACES exam takes over half a day in a clinical setting. You will have to go through five different clinical stations, each lasting approx 20 minutes, with a five-minute break between each station. The five minutes at Stations 1, 2, 4, and 5 are used to read the clinical scenarios.

You will have 8 encounters in total. An encounter is when you interact with a patient or surrogate for examination. Stations 2 and 5 consist of 1 encounter, while stations 1, 3, and 4 consist of 2 encounters.

From the third assessment period of PACES 2023, which is September to December 2023, MRCP (UK) decided to introduce a new format of the exam called PACES23. The new format tests the same skills and includes 5 clinical stations. However, some of the encounters were altered to reflect the changes in postgraduate medical education and better accommodate the different challenges doctors face in the 21st century.

The different stations since the third diet of 2023 include:

• Station 1: Respiratory Examination (10 minutes) and Communication (10 minutes)
• Station 2: Consultation (20 minutes)
• Station 3: Cardiovascular examination (10 minutes) and Neurological examination (10 minutes)
• Station 4: Communication (10 minutes) and Abdominal examination (10 minutes)
• Station 5: Consultation (20 minutes)

 Here is a visual representation of how the PACES will be conducted: 

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What are the clinical skills assessed during MRCP PACES?

The PACES exam has been designed to assess your ability to carry out a wide range of essential skills in a clinical setting, including your clinical knowledge, communication skills, and professional behaviour. It helps prove that you are ready to provide a high standard of care for your patients.

During the exam, you will be judged by 10 independent examiners, 2 at each station. They will observe and evaluate your performance.

To increase your chances of passing the exam, it is important to understand the different clinical skills that the examiners will be looking for. The seven different core skills that are assessed have been mentioned below:

    1. Physical examination

    2. Identifying physical signs

    3. Clinical communication

    4. Differential diagnosis

    5. Clinical judgement

    6. Managing Patients’ Concerns

    7. Maintaining patient welfare

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The examiners will grade your skills as Satisfactory (2 marks), Borderline (1 mark), or Unsatisfactory (0 marks).

To pass MRCP PACES, you must pass all seven skills and achieve a minimum of 126 marks out of 168. 

Here is the current pass standard (Valid till 1 April 2024):

How much does MRCP PACES cost? 

At present, the examination fee for MRCP PACES is £1202. However, the fees for the three MRCP (UK) exams will change effective 1st July 2024. Here are the details of the current and revised fee structure.

MRCP PACES Exam 2024 in India: How to Apply & When?

The PACES exam in 2024 will be conducted in 3 assessment periods. Here is a breakdown of the application dates for each assessment period.

While filling out your application, we recommend keeping the following details handy:

• Names and addresses of the hospitals you have worked at in the last 12 months.
• Any training undergone in the last 12 months.
• Dates of PACES courses, if any.
• Dates of previous PACES attempts, if any.

In India, there are 9 locations where you can appear for MRCP PACES. These are Bengaluru, Chennai, Hyderabad, Kochi, Kolkata, New Delhi, Pondicherry, Pune and Thiruvananthapuram. 

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The application period lasts for a week, allowing you to apply at any time within that period, as there is no first come, first serve basis. The application process is as follows:

     1) Log in to your My MRCP (UK) account.

     2) Check that all your details are up-to-date. Make any changes, if necessary.

     3) Select whether you are training in the UK or any other country.

     4) Choose your location for taking MRCP PACES. You can choose up to 4 locations. 

     5) If you have any disability or require any special arrangements, mention them.

     6) Fill in the details of your past 12 months’ work history and training. Also, you must provide the details of your previous PACES attempts and any PACES courses undertaken.

     7) Submit your application.

You do not need to pay the fees for the exam at this stage. The payment is done only after your application has been approved.

The application outcome is revealed within 3 weeks of the closing date. After the application outcome has been revealed, you will have 2 weeks to make the payment. You can either use a PayPal account or your debit/credit card for it. Here are the instructions on how to pay the MRCP PACES fees. 

How to prepare for MRCP PACES?

Now, let’s dive into preparing for MRCP PACES. The exam has been known to set rigorous standards, which makes it difficult to pass. Many clinical trainees in the UK spend a lot of time and money preparing for it, and most of them have to attempt it more than once.  

While many videos and courses are available to help you prepare for PACES, your medical training will come in handy during the examination period. Be mindful of how you act in clinical settings, as this will ensure that the same behaviour is exhibited at the examination centre.

Let’s talk about the resources available!

You can work through the past questions that are available on the MRCP (UK) website. The link can be found here. Additionally, we also recommend listening to the podcast series, Demystifying PACES, which has been developed by their Training And Members’ Committee (T&MC) at The Royal College of Physicians. 

For videos, we recommend subscribing to both ClincalSkillPro and Pastest, as both of them offer high-quality patient videos.

Lastly, here are the two paid courses that can help you prepare for PACES. 

    1) Evening Medical Updates by the Royal College of Physicians of Edinburgh encompasses the specialities, presentations, and conditions that are a part of the Internal Medicine Training (IMT) curriculum.

    2) The e-learning module by the Royal College of Physicians and Surgeons of Glasgow offers tips and guidance on appearing for PACES.

Tips to keep in mind for MRCP PACES

 Here are the top 5 tips you should keep in mind while preparing for MRCP PACES:

Tip 1: Scope of the subject: 

The exam is designed to assess your clinical proficiency through patient interactions. Spend time learning about the stations, how to take a history, perform a physical examination, follow appropriate procedures, and communicate clearly.

Tip 2: Get familiar with the exam sequence:

All the stations have a specific examination sequence. In the communication exam, you are handed a set of written instructions and you get 5 minutes to prepare. Then, you are given 10 minutes to interview the patient/surrogate.

In the consultation section at Stations 2 and 5, you will be again given written instructions with 5 minutes to prepare. After that, you will be required to interview and examine the patient/surrogate for 15 minutes. The remaining 5 minutes are spent answering the examiner’s questions.

During the rest of the examinations, you are given a set of brief written instructions and will be required to respond to them by examining the patient. You are given 6 minutes for the examination, with the rest 4 minutes spent answering the examiner’s questions.

During all 8 encounters, it is your responsibility to ensure the necessary skills are demonstrated.

To help prepare for the exam, standardise your examination sequence and start practising it with your existing patients so it becomes a habit and you don’t waste time asking unnecessary questions 

Tip 3: Be concise and communicate well

An important part of the MRCP PACES exam is the ability to accumulate your thoughts and communicate your findings.

Due to the time constraint, if you spend too much time talking about the physical signs and symptoms, the examiner does not get enough time to ask other important questions like management. Therefore, make it a habit to note down important points during interviews and examinations, which makes it easier to organise your thoughts.

There are generally two ways to present your findings: peripheral symptoms to the conclusion or tell the diagnosis first and then deep dive into the signs and symptoms. There's no one right way to do it, and you should choose the approach that works best for you. The most important thing is to ensure that your answer is logical and relevant to the question.

Tip 4: Find a PACES examiner 

If you can find a consultant who is also a PACES examiner, you will have hit the jackpot. They can give you information on the skills they are looking for, their guidance, and tips that can help you be better prepared.

Also, some places may have common scenarios that come up during the PACES examination, even though you can be asked anything. Speak to colleagues who have appeared for the examination to learn about the situations that came up for them. Also, familiarise yourself with the common ailments and illnesses found in the region you are appearing for MRCP PACES. 

Tip 5: Practice, practice, and practice

Find a colleague or a friend who you work well with and prepare for the PACES exam together. This can make the preparation less strenuous and more enjoyable. Additionally, you can also ask your colleagues and bosses at your hospital who have passed PACES to observe and give you feedback on your behaviour. 

Use the feedback to make improvements. 

Passed MRCP PACES, What next? 

Cleared MRCP PACES! You should be proud of your hard work and achievement.

If you have followed the usual route of Part 1, Part 2, and PACES, then you have gained access to GMC registration. 

The process for GMC Registration is as follows:

1. Login to your GMC Online account
2. Go to My Registration > My Application
3. Fill out all the required details and attach supporting documents
4. Answer 10 questions related to your health and fitness
5. Pay a registration fee. The fee details are mentioned here.
6. Submit the application

GMC carries out the initial assessment within 5 working days, provided that all the documents have been submitted. If they require additional documents, you will be contacted via email. 

After your application has been approved, you will also be required to undergo a GMC identity check within 3 months of application approval. 

Now, the documents and details that you will require during the online application are:

• Evidence of primary medical qualification.
• A postgraduate medical qualification, which is MRCP in your case.
• An IELTS or OET certification within the last 2 years to prove your English knowledge.
• A copy of your passport’s photo ID and signature page.
• A valid certificate of good standing from every medical authority that you have been registered or licenced to work within the last 5 years. Each certificate is valid for only 3 months from the date of sign. 
• Details of medical and non-medical experiences from within the last 5 years. You will need employment references for non-medical work, medical work without registration or licence to practice or an observership or clinical attachment that exceeds 2 months. 

Once all the steps are completed, you can pursue specialist training, and at the same time apply for non-training ST3+ roles.

How can TERN help?

After completing the examination, receiving your diploma, and registering with GMC, you can start applying for roles in the UK. TERN can help you with this!

TERN is an all-around upskilling, global migration, and placement platform. We help doctors in India find their dream job in the UK from vetted employers that offer immense potential to grow. Our services go a step further by assisting at every step of migrating to another country, from reference checks and compliance to integration post-offer and managing relocation.

Get in touch with us to know how TERN can help you be placed in a top healthcare job with a reputed employer in the UK.